The use of oxygen reserve index in one-lung ventilation and its impact on peripheral oxygen saturation, perfusion index and, pleth variability index

Abstract Background Our goal is to investigate the use of the oxygen reserve index (ORi) to detect hypoxemia and its relation with parameters such as; peripheral oxygen saturation, perfusion index (PI), and pleth variability index (PVI) during one-lung ventilation (OLV). Methods Fifty patients undergoing general anesthesia and OLV for elective thoracic surgeries were enrolled in an observational cohort study in a tertiary care teaching hospital. All patients required OLV after a left-sided double-lumen tube insertion during intubation. The definition of hypoxemia during OLV is a peripheral oxygen saturation (SpO2) value of less than 95%, while the inspired oxygen fraction (FiO2) is higher than 50% on a pulse oximetry device. ORi, pulse oximetry, PI, and PVI values were measured continuously. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and accuracy were calculated for ORi values equal to zero in different time points during surgery to predict hypoxemia. At Clinicaltrials.gov registry, the Registration ID is NCT05050552. Results Hypoxemia was observed in 19 patients (38%). The accuracy for predicting hypoxemia during anesthesia induction at ORi value equals zero at 5 min after intubation in the supine position (DS5) showed a sensitivity of 92.3% (95% CI 84.9–99.6), specificity of 81.1% (95% CI 70.2–91.9), and an accuracy of 84.0% (95% CI 73.8–94.2). For predicting hypoxemia, ORi equals zero show good sensitivity, specificity, and statistical accuracy values for time points of DS5 until OLV30 where the sensitivity of 43.8%, specificity of 64%, and an accuracy of 56.1% were recorded. ORi and SpO2 correlation was found at DS5, 5 min after lateral position with two-lung ventilation (DL5) and at 10 min after OLV (OLV10) (p = 0.044, p = 0.039, p = 0.011, respectively). Time-dependent correlations also showed that; at a time point of DS5, ORi has a significant negative correlation with PI whereas, no correlations with PVI were noted. Conclusions During the use of OLV for thoracic surgeries, from 5 min after intubation (DS5) up to 30 min after the start of OLV, ORi provides valuable information in predicting hypoxemia defined as SpO2 less than 95% on pulse oximeter at FiO2 higher than 50%.

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The Use of Oxygen Reserve Index in One-Lung Ventilation and Its Impact On Peripheral Oxygen Saturation, Perfusion Index and Pleth Variability Index

10.21203/rs.3.rs-990585/v1 ◽

2021 ◽

Author(s):

Gonul Sagiroglu ◽

Ayse Baysal ◽

Yekta Altemur Karamustafaoglu

Keyword(s):

Oxygen Saturation ◽

Pulse Oximetry ◽

General Anesthesia ◽

Supine Position ◽

Lung Ventilation ◽

Anesthesia Induction ◽

Pleth Variability Index ◽

One Lung Ventilation ◽

Peripheral Oxygen Saturation ◽

Variability Index

Abstract Background: Our goal is to investigate the use of the Oxygen Reserve Index (ORi) and its relation with peripheral oxygen saturation, perfusion index (PI), and pleth variability index (PVI) during one-lung ventilation (OLV).Methods: Fifty patients undergoing general anesthesia and OLV for elective thoracic surgeries were enrolled in an observational cohort study in a tertiary care teaching hospital. During general anesthesia induction, propofol, fentanyl, and rocuronium at appropriate doses were administered intravenously. All patients required OLV after a left-sided double-lumen tube insertion during intubation. Hypoxemia during OLV was defined as peripheral oxygen saturation (SpO2) value of less than 95% when the inspired oxygen fraction (FiO2) is above 60% on a pulse oximetry device. ORi, pulse oximetry, PI, and PVI were measured continuously. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and accuracy were calculated for ORi equals zero in different anesthesia time points to predict hypoxemia. At Clinicaltrials.gov registry, the Registration ID is NCT05050552.Results: The accuracy for predicting hypoxemia during anesthesia induction at ORi value equals zero at five minutes after intubation in the supine position (DS5) showed a sensitivity of 92.3% (95% CI 84.9-99.6), specificity of 81.1% (95% CI 70.2-91.9), and an accuracy of 84.0% (95% CI 73.8- 94.2). ORi and SpO2 correlation was found at DS5 (p = 0.044), 5 minutes after lateral position with two-lung ventilation (DL5) (p = 0.039), and at 10 minutes after OLV (OLV10)(p = 0.011).Conclusions: ORi equals zero at the time point of five minutes after tracheal intubation in the supine position (DS5) showed high sensitivity and specificity for predicting hypoxemia at a less than 95% value.

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EARLY DETECTION AND MANAGEMENT OF CRITICALLY SICK NEWBORN IN NEONATAL INTENSIVECARE UNIT USING PERFUSION INDEX AND PLETH VARIABILITY INDEX IN ADVANCED PULSE OXIMETRY

Indian Journal of Child Health ◽

10.32677/ijch.2014.v01.i03.016 ◽

2014 ◽

Vol 01 (03) ◽

pp. 158-159

Author(s):

Pankaj Kumar Mohanty ◽

Jitesh Chavda ◽

Mrinal S Pillai ◽

Deepa M Sharma ◽

Siddu Charki

Keyword(s):

Early Detection ◽

Pulse Oximetry ◽

Perfusion Index ◽

Pleth Variability Index ◽

Sick Newborn ◽

Variability Index

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Current Ventilator and Oxygen Management during General Anesthesia

Anesthesiology ◽

10.1097/aln.0000000000002181 ◽

2018 ◽

Vol 129 (1) ◽

pp. 67-76 ◽

Cited By ~ 7

Author(s):

Satoshi Suzuki ◽

Yuko Mihara ◽

Yukiko Hikasa ◽

Shuji Okahara ◽

Takuma Ishihara ◽

...

Keyword(s):

Oxygen Saturation ◽

Pulse Oximetry ◽

General Anesthesia ◽

Oxygen Tension ◽

Multivariable Analysis ◽

Lung Ventilation ◽

Volume Control ◽

One Lung Ventilation ◽

Oxygen Exposure ◽

Inspired Oxygen

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.

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