Perioperative Medicine  |   July 2018
Current Ventilator and Oxygen Management during General Anesthesia: A Multicenter, Cross-sectional Observational Study
Author Notes
  • From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan (S.S., Y.M., Y.H., S.O., H.M.); and Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan (T.I., A.S.).
  • Atago Hospital, Kochi
  • Chikamori Hospital, Kochi
  • Fukuyama City Hospital, Hiroshima
  • Fukuyama Medical Center, Hiroshima
  • Himeji Central Hospital, Hyogo
  • Hiroshima City Hiroshima Citizens Hospital, Hiroshima
  • Iwakuni Medical Center, Yamaguchi
  • Japanese Red Cross Kobe Hospital, Hyogo
  • Japanese Red Cross Okayama Hospital, Okayama
  • Japanese Red Cross Society Himeji Hospital, Hyogo
  • Japanese Red Cross Society Mihara Hospital, Hiroshima
  • Jichi Medical University Hospital, Tochigi
  • Kagawa Prefectural Central Hospital, Kagawa
  • Kagawa Rosai Hospital, Kagawa
  • Kajiki Hospital, Okayama
  • Kameda Medical Center, Chiba
  • Kawasaki Medical School General Medical Center, Okayama
  • Kawasaki Medical School Hospital, Okayama
  • Kobe University Hospital, Hyogo
  • Kochi Health Sciences Center, Kochi
  • Kochi Medical School Hospital, Kochi
  • Kurashiki Medical Center, Okayama
  • Maizuru Kyosai Hospital, Kyoto
  • Matsuda Hospital, Okayama
  • Mitoyo General Hospital, Kagawa
  • Mizushima Kyodo Hospital, Okayama
  • National Cancer Center Hospital, Tokyo
  • Okayama City Hospital, Okayama
  • Okayama Kyokuto Hospital, Okayama
  • Okayama Kyoritsu General Hospital, Okayama
  • Okayama Medical Center, Okayama
  • Okayama Rosai Hospital, Okayama
  • Okayama Saiseikai General Hospital, Okayama
  • Onomichi Municipal Hospital, Hiroshima
  • Saiseikai Imabari Hospital, Ehime
  • Shizuoka Cancer Center, Shizuoka
  • Showa University Northern Yokohama Hospital, Kanagawa
  • Takasago Municipal Hospital, Hyogo
  • Takinomiya General Hospital, Kagawa
  • Tottori Municipal Hospital, Tottori
  • Tsuyama Chuo Hospital, Okayama
  • Yashima General Hospital, Kagawa
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication June 27, 2017. Accepted for publication February 15, 2018.
    Submitted for publication June 27, 2017. Accepted for publication February 15, 2018.×
  • *Members of the Okayama Research Investigation Organizing Network (ORION) investigators are listed in the appendix.
    Members of the Okayama Research Investigation Organizing Network (ORION) investigators are listed in the appendix.×
  • Address correspondence to Dr. Suzuki: Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama 700-8558, Japan. suzuki-s@mtc.biglobe.ne.jp. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Airway Management / Respiratory System / Technology / Equipment / Monitoring / Thoracic Anesthesia
Perioperative Medicine   |   July 2018
Current Ventilator and Oxygen Management during General Anesthesia: A Multicenter, Cross-sectional Observational Study
Anesthesiology 7 2018, Vol.129, 67-76. doi:10.1097/ALN.0000000000002181
Anesthesiology 7 2018, Vol.129, 67-76. doi:10.1097/ALN.0000000000002181
Abstract

Background: Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia.

Methods: A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1 h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%).

Results: A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60).

Conclusions: Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.