• Alex Choi, Hao Deng, Mitchell Fuller, Jamie L Sparling, Min Zhu, Brooks Udelsman, Gyorgy Frendl, Vidal MeloMarcos FMFDepartment of Anesthesiology, Columbia University Irving Medical Center, 630 W 168th St New York, NY 10032, USA., and Alexander Nagrebetsky.
• Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710, USA.
• J Clin Anesth. 2025 Jan 3; 101: 111739111739.

Study ObjectiveTo assess whether, in a lung resection cohort with a low probability of confounding by indication, higher FiO2 is associated with an increased risk of impaired postoperative oxygenation - a clinical manifestation of lung injury/dysfunction.DesignPre-specified registry-based retrospective cohort study.SettingTwo large academic hospitals in the United States.Patients2936 lung resection patients with an overall good intraoperative oxygenation (median intraoperative SpO2 ≥ 95 %).MeasurementsWe compared patients with a higher (≥0.8) and lower (<0.8) median intraoperative FiO2 after propensity score-weighting for 75 perioperative variables based on a causal inference framework. The primary outcome of impaired oxygenation 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) at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50 % oxygen or high-flow oxygen).Main ResultsAmong the 2936 included patients, 2171 (73.8 %) received median intraoperative FiO2 ≥ 0.8. Impaired postoperative oxygenation occurred in 1627 (74.9 %) and 422 (55.2 %) patients in the higher and lower FiO2 groups, respectively. In a propensity score-weighted analysis, higher intraoperative FiO2 was associated with an 84 % increase in the likelihood of impaired postoperative oxygenation (OR 1.84; 95 % CI 1.60 to 2.12; P < 0.001).ConclusionsDespite plausible harm from hyperoxia, high intraoperative FiO2 is extremely common during lung resection. Nearly three-quarters of lung resection patients with acceptable oxygenation received median intraoperative FiO2 ≥ 0.8. Such higher FiO2 was associated with an increased risk of impaired postoperative oxygenation - a clinically relevant manifestation of lung injury or dysfunction. This observation supports the administration of a lower (< 0.8) intraoperative FiO2 and its further assessment in clinical trials.Copyright © 2024 Elsevier Inc. All rights reserved.

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