• Alexander Nagrebetsky, Min Zhu, Hao Deng, Henning A Gaissert, Gama de AbreuMarceloMDepartment of Cardiothoracic Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Out, Gyorgy Frendl, Maximilian S Schaefer, and Vidal MeloMarcos FMFDivision of Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA..
• Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: anagrebetsky@mgh.harvard.edu.
• J Clin Anesth. 2024 Sep 1; 96: 111485111485.

Study ObjectiveTo estimate the incidence of postoperative oxygenation impairment after lung resection in the era of lung-protective management, and to identify perioperative factors associated with that impairment.DesignRegistry-based retrospective cohort study.SettingTwo large academic hospitals in the United States.Patients3081 ASA I-IV patients undergoing lung resection.Measurements79 pre- and intraoperative variables, selected for inclusion based on a causal inference framework. The primary outcome of impaired oxygenation, an early marker of lung injury, was defined as at least one of the following within seven postoperative days: (1) SpO2 < 92%; (2) imputed PaO2/FiO2 < 300 mmHg [(1) or (2) occurring at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50% oxygen or high-flow oxygen).Main ResultsOxygenation was impaired within seven postoperative days in 70.8% of patients (26.6% with PaO2/FiO2 < 200 mmHg or intensive oxygen therapy). In multivariable analysis, each additional cmH2O of intraoperative median driving pressure was associated with a 7% higher risk of impaired oxygenation (OR 1.07; 95%CI 1.04 to 1.10). Higher median intraoperative FiO2 (OR 1.23; 95%CI 1.14 to 1.31 per 0.1) and PEEP (OR 1.12; 95%CI 1.04 to 1.21 per 1 cm H2O) were also associated with increased risk. History of COPD (OR 2.55; 95%CI 1.95 to 3.35) and intraoperative albuterol administration (OR 2.07; 95%CI 1.17 to 3.67) also showed reliable effects.ConclusionsImpaired postoperative oxygenation is common after lung resection and is associated with potentially modifiable pre- and intraoperative respiratory factors.Copyright © 2023. Published by Elsevier Inc.

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