Effects of different fractions of inspired oxygen on delayed neurocognitive recovery in patients with one-lung ventilation: a randomized clinical trial

Wu, Chujun1,2; Zhang, Wangzhi1; Lin, Jun3; Zhao, Dizhou4; Fang, Jieyu1,5,*

Author Information

1Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China

2Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China

3Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China

4Department of Anesthesiology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong Province, China

5Department of Anesthesiology, Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, Nanning, Guangxi Zhuang Autonomous Region, China

*Correspondence to: Jieyu Fang, MD, fangjy@mail.sysu.edu.cn

Funding:This study was supported by a self-financed scientific research project of the Guangxi Zhuang Autonomous Region Health Commission (No. Z-A20240167).

Abstract

Delayed neurocognitive recovery is an important cause of morbidity and disability after surgery. This perspective randomized clinical study mainly explored the effects of different fractions of inspired oxygen (FiO2) on Delayed neurocognitive recovery in patients with one-lung ventilation. Between December 2021 and July 2022, 88 patients aged 30–70 years who underwent thoracoscopic pulmonary lobectomy with one-lung ventilation at the First Affiliated Hospital of Sun Yat-sen University, China, were divided into two groups. One group received 70% FiO2 (70% FiO2 group), while the other received 100% FiO2 (100% FiO2 group) during one-lung ventilation. The outcomes were the incidence of delayed neurocognitive recovery on postoperative days 1 and 3, the incidence of cerebral oxygen desaturation during surgery, and the perioperative level of blood gas, inflammatory response, and oxidative stress. The incidence rates of cerebral oxygen desaturation and delayed neurocognitive recovery on postoperative days 1 and 3 were similar between the two groups. Compared with the 70% FiO2 group, in the 100% FiO2 group, the oxygenation index was significantly higher at 30 minutes after one-lung ventilation and 60 minutes after one-lung ventilation, and the arterial partial pressure of carbon dioxide was significantly lower at 15, 30 and 60 minutes after one-lung ventilation, while that of superoxide dismutase was significantly lower at 15 minutes after one-lung ventilation. Compared with 70% FiO2, 100% FiO2 did not increase the incidence of delayed neurocognitive recovery on days 1 and 3 post-operatively in patients with one-lung ventilation.

摘要

神经认知恢复延迟是术后致残和致病的重要原因。这项前瞻性随机临床研究主要探讨了不同吸入氧浓度对单肺通气患者神经认知恢复延迟的影响。研究纳入了2021年12月至2022年7月期间在中国中山大学附属第一医院接受胸腔镜肺叶切除术并采用单肺通气的88例患者，年龄30-70岁，并将其分为两组。一组在单肺通气期间接受70%吸入氧浓度（70% FiO2组），另一组接受100%吸入氧浓度（100% FiO2组）。观察指标为术后第1天和第3天神经认知恢复延迟的发生率、术中脑氧饱和度下降的发生率以及围手术期的血气水平、炎症反应和氧化应激水平。两组患者术中脑氧饱和度下降的发生率以及术后第1天和第3天神经认知恢复延迟的发生率相似。与70% FiO2组相比，100% FiO2组在单肺通气后30分钟和60分钟的氧合指数显著更高，而在单肺通气后15、30和60分钟的动脉血二氧化碳分压显著更低；但在单肺通气后15分钟的超氧化物歧化酶水平显著更低。与70% FiO2相比，100% FiO2并未增加单肺通气患者术后第1天和第3天神经认知恢复延迟的发生率。