High inspired oxygen fraction impairs lung volume and ventilation heterogeneity in healthy children

a double-blind randomised controlled trial

Béatrice de la Grandville, F. Peták, Gergely Albu, Sam Bayat, Isabelle Pichon, Walid Habre

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Although a high inspired oxygen fraction (FiO 2 ) is commonly used in paediatric anaesthesia, the impact on postoperative lung function is unclear. We compared lung volume, ventilation heterogeneity, and respiratory mechanics in anaesthetised children randomised to receive low or high FiO 2 intraoperatively. Methods: In a double-blind randomised controlled trial, children scheduled for elective surgery were randomly assigned FiO 2 100% (n=29) or FiO 2 80% (n=29) during anaesthesia induction and emergence. During maintenance of anaesthesia, participants assigned FiO 2 =100% at induction/emergence received FiO 2 =80% (FiO 2 >0.8 group); those randomised to FiO 2 =80% at induction/emergence received FiO 2 =35% intraoperatively (FiO 2 [0.8→0.35 group]). During spontaneous breathing, we measured the (i) functional residual capacity (FRC) and lung clearance index (ventilation inhomogeneity) by multiple-breath nitrogen washout; and (ii) airway resistance and respiratory tissue elastance by forced oscillations, before operation, after discharge from the recovery room, and 24 h after operation. Mean (95% confidence intervals) are reported. Results: Fifty eight children (12.9 [12.3–13.5] yr) were randomised; 22/29 (high group) and 21/29 (low group) children completed serial multiple-breath nitrogen washout measurements. FRC decreased in the FiO 2 >0.8 group after discharge from recovery (–12.0 [–18.5 to –5.5]%; P=0.01), but normalised 24 h later. Ventilation inhomogeneity increased in both groups after discharge from recovery, but persisted in the FiO 2 >0.8 group 24 h after surgery (6.1 [2.5–9.8%]%; P=0.02). Airway resistance and respiratory elastance did not differ between the groups at any time point. Conclusions: FiO 2 >0.8 decreases lung volume in the immediate postoperative period, accompanied by persistent ventilation inhomogeneity. These data suggest that FiO 2 >0.8 should be avoided in anaesthetised children with normal lungs. Clinical trial registration: NCT02384616.

Original languageEnglish
JournalBritish Journal of Anaesthesia
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Ventilation
Randomized Controlled Trials
Oxygen
Lung
Functional Residual Capacity
Airway Resistance
Anesthesia
Nitrogen
Respiratory Mechanics
Recovery Room
Postoperative Period
Respiration
Maintenance
Clinical Trials
Confidence Intervals
Pediatrics

Keywords

  • functional residual capacity
  • hyperoxia
  • lung function
  • mechanical ventilation
  • paediatric anaesthesia
  • ventilation heterogeneity

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

High inspired oxygen fraction impairs lung volume and ventilation heterogeneity in healthy children : a double-blind randomised controlled trial. / Grandville, Béatrice de la; Peták, F.; Albu, Gergely; Bayat, Sam; Pichon, Isabelle; Habre, Walid.

In: British Journal of Anaesthesia, 01.01.2019.

Research output: Contribution to journalArticle

@article{686faf32bb834b089e1ac682a0ddec55,
title = "High inspired oxygen fraction impairs lung volume and ventilation heterogeneity in healthy children: a double-blind randomised controlled trial",
abstract = "Background: Although a high inspired oxygen fraction (FiO 2 ) is commonly used in paediatric anaesthesia, the impact on postoperative lung function is unclear. We compared lung volume, ventilation heterogeneity, and respiratory mechanics in anaesthetised children randomised to receive low or high FiO 2 intraoperatively. Methods: In a double-blind randomised controlled trial, children scheduled for elective surgery were randomly assigned FiO 2 100{\%} (n=29) or FiO 2 80{\%} (n=29) during anaesthesia induction and emergence. During maintenance of anaesthesia, participants assigned FiO 2 =100{\%} at induction/emergence received FiO 2 =80{\%} (FiO 2 >0.8 group); those randomised to FiO 2 =80{\%} at induction/emergence received FiO 2 =35{\%} intraoperatively (FiO 2 [0.8→0.35 group]). During spontaneous breathing, we measured the (i) functional residual capacity (FRC) and lung clearance index (ventilation inhomogeneity) by multiple-breath nitrogen washout; and (ii) airway resistance and respiratory tissue elastance by forced oscillations, before operation, after discharge from the recovery room, and 24 h after operation. Mean (95{\%} confidence intervals) are reported. Results: Fifty eight children (12.9 [12.3–13.5] yr) were randomised; 22/29 (high group) and 21/29 (low group) children completed serial multiple-breath nitrogen washout measurements. FRC decreased in the FiO 2 >0.8 group after discharge from recovery (–12.0 [–18.5 to –5.5]{\%}; P=0.01), but normalised 24 h later. Ventilation inhomogeneity increased in both groups after discharge from recovery, but persisted in the FiO 2 >0.8 group 24 h after surgery (6.1 [2.5–9.8{\%}]{\%}; P=0.02). Airway resistance and respiratory elastance did not differ between the groups at any time point. Conclusions: FiO 2 >0.8 decreases lung volume in the immediate postoperative period, accompanied by persistent ventilation inhomogeneity. These data suggest that FiO 2 >0.8 should be avoided in anaesthetised children with normal lungs. Clinical trial registration: NCT02384616.",
keywords = "functional residual capacity, hyperoxia, lung function, mechanical ventilation, paediatric anaesthesia, ventilation heterogeneity",
author = "Grandville, {B{\'e}atrice de la} and F. Pet{\'a}k and Gergely Albu and Sam Bayat and Isabelle Pichon and Walid Habre",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.bja.2019.01.036",
language = "English",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",

}

TY - JOUR

T1 - High inspired oxygen fraction impairs lung volume and ventilation heterogeneity in healthy children

T2 - a double-blind randomised controlled trial

AU - Grandville, Béatrice de la

AU - Peták, F.

AU - Albu, Gergely

AU - Bayat, Sam

AU - Pichon, Isabelle

AU - Habre, Walid

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Although a high inspired oxygen fraction (FiO 2 ) is commonly used in paediatric anaesthesia, the impact on postoperative lung function is unclear. We compared lung volume, ventilation heterogeneity, and respiratory mechanics in anaesthetised children randomised to receive low or high FiO 2 intraoperatively. Methods: In a double-blind randomised controlled trial, children scheduled for elective surgery were randomly assigned FiO 2 100% (n=29) or FiO 2 80% (n=29) during anaesthesia induction and emergence. During maintenance of anaesthesia, participants assigned FiO 2 =100% at induction/emergence received FiO 2 =80% (FiO 2 >0.8 group); those randomised to FiO 2 =80% at induction/emergence received FiO 2 =35% intraoperatively (FiO 2 [0.8→0.35 group]). During spontaneous breathing, we measured the (i) functional residual capacity (FRC) and lung clearance index (ventilation inhomogeneity) by multiple-breath nitrogen washout; and (ii) airway resistance and respiratory tissue elastance by forced oscillations, before operation, after discharge from the recovery room, and 24 h after operation. Mean (95% confidence intervals) are reported. Results: Fifty eight children (12.9 [12.3–13.5] yr) were randomised; 22/29 (high group) and 21/29 (low group) children completed serial multiple-breath nitrogen washout measurements. FRC decreased in the FiO 2 >0.8 group after discharge from recovery (–12.0 [–18.5 to –5.5]%; P=0.01), but normalised 24 h later. Ventilation inhomogeneity increased in both groups after discharge from recovery, but persisted in the FiO 2 >0.8 group 24 h after surgery (6.1 [2.5–9.8%]%; P=0.02). Airway resistance and respiratory elastance did not differ between the groups at any time point. Conclusions: FiO 2 >0.8 decreases lung volume in the immediate postoperative period, accompanied by persistent ventilation inhomogeneity. These data suggest that FiO 2 >0.8 should be avoided in anaesthetised children with normal lungs. Clinical trial registration: NCT02384616.

AB - Background: Although a high inspired oxygen fraction (FiO 2 ) is commonly used in paediatric anaesthesia, the impact on postoperative lung function is unclear. We compared lung volume, ventilation heterogeneity, and respiratory mechanics in anaesthetised children randomised to receive low or high FiO 2 intraoperatively. Methods: In a double-blind randomised controlled trial, children scheduled for elective surgery were randomly assigned FiO 2 100% (n=29) or FiO 2 80% (n=29) during anaesthesia induction and emergence. During maintenance of anaesthesia, participants assigned FiO 2 =100% at induction/emergence received FiO 2 =80% (FiO 2 >0.8 group); those randomised to FiO 2 =80% at induction/emergence received FiO 2 =35% intraoperatively (FiO 2 [0.8→0.35 group]). During spontaneous breathing, we measured the (i) functional residual capacity (FRC) and lung clearance index (ventilation inhomogeneity) by multiple-breath nitrogen washout; and (ii) airway resistance and respiratory tissue elastance by forced oscillations, before operation, after discharge from the recovery room, and 24 h after operation. Mean (95% confidence intervals) are reported. Results: Fifty eight children (12.9 [12.3–13.5] yr) were randomised; 22/29 (high group) and 21/29 (low group) children completed serial multiple-breath nitrogen washout measurements. FRC decreased in the FiO 2 >0.8 group after discharge from recovery (–12.0 [–18.5 to –5.5]%; P=0.01), but normalised 24 h later. Ventilation inhomogeneity increased in both groups after discharge from recovery, but persisted in the FiO 2 >0.8 group 24 h after surgery (6.1 [2.5–9.8%]%; P=0.02). Airway resistance and respiratory elastance did not differ between the groups at any time point. Conclusions: FiO 2 >0.8 decreases lung volume in the immediate postoperative period, accompanied by persistent ventilation inhomogeneity. These data suggest that FiO 2 >0.8 should be avoided in anaesthetised children with normal lungs. Clinical trial registration: NCT02384616.

KW - functional residual capacity

KW - hyperoxia

KW - lung function

KW - mechanical ventilation

KW - paediatric anaesthesia

KW - ventilation heterogeneity

UR - http://www.scopus.com/inward/record.url?scp=85062632853&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062632853&partnerID=8YFLogxK

U2 - 10.1016/j.bja.2019.01.036

DO - 10.1016/j.bja.2019.01.036

M3 - Article

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

ER -