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Hyperoxia: a review of the risks and benefits in adult cardiac surgery.
MedLine Citation:
PMID:  23441567     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Perioperative hyperoxia has been claimed to have a number of therapeutic advantages. However, in the setting of cardiac surgery and cardiopulmonary bypass (CPB), enthusiasm for its use has been tempered by concerns regarding the effect of high partial pressures of oxygen on cardiac, vascular, and respiratory function and the potential for exacerbation of ischemia-reperfusion injury. There is encouraging evidence from animal studies that hyperoxia is effective in myocardial preconditioning, at least in nondiseased hearts. There is also evidence that hyperoxia reduces gas microemboli production and longevity during CPB, although it is unclear whether this translates into a clinical benefit in terms of a reduction in postoperative neurological morbidity. Hyperoxia leads to changes in cardiovascular function. However, the effects of these changes remain unclear. At a tissue level, there is evidence that hyperoxia does not lead to improvement in partial pressure of oxygen. Indeed, the opposite may be the case with reductions in capillary density leading to areas of reduced tissue oxygenation. The risks of hyperoxia in association with CPB include lung injury, increased systemic reactive oxygen species generation, and exacerbation of reactive oxygen species-mediated myocardial injury at the time of reperfusion. Again, it is difficult to know whether the changes demonstrated are temporary or if they translate into a worsening of clinical outcomes. In conclusion, perhaps the key to the use of hyperoxia is in the timing. In the period pre-CPB, hyperoxia may precondition the myocardium and, paradoxically, confer a degree of protection against reactive oxygen species-induced injury at the time of reperfusion. Hyperoxia during CPB is probably harmful and should be avoided unless the risk from gas microemboli is thought to be significant, in which case the risks and benefits to the individual patient must be weighed.
Authors:
Robert W Young
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of extra-corporeal technology     Volume:  44     ISSN:  0022-1058     ISO Abbreviation:  J Extra Corpor Technol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2013-02-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267637     Medline TA:  J Extra Corpor Technol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  241-9     Citation Subset:  T    
Affiliation:
Anaesthesia and Pain Management, Flinders Medical Centre, Adelaide, Australia. Young2@health.sa.gov.au
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