Evaluation of the introduction of conservative oxygen therapy compared to normal oxygen therapy practice in patients undergoing cardiac surgery: A before and after audit

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Cardiac surgical patients routinely receive supplemental oxygen immediately prior to, during and immediately following their cardiac surgical procedure. A major goal of anaesthetic care of the cardiac surgical patient is the maintenance of haemodynamic stability as well as the preservation of myocardial and systemic tissue oxygenation. Often cardiac surgical patients will receive supplemental oxygen and have supra-normal concentration of oxygen as a buffer of safety (Ihnken et al., 1998). However, cardiac surgical patients are particular susceptible to lung and myocardial injury attributable to hyperoxic states. Reactive oxygen species (ROS) are well known for their role in myocardial injury. ROS are free radicals (unpaired electrons) involved with oxidation-reduction reactions with other molecules. During cardiac surgery the formation of oxygen free radicals is accelerated from tissue injury and the use of cardiopulmonary bypass. Clinical studies have demonstrated apoptosis and deoxyribonucleic acid (DNA) fragmentation occurring after ischemia-reperfusion injury. In addition, prolonged high oxygen concentrations have been shown to decrease myocardial contractility and a decrease in heart rate which results in impaired cardiac function and may delay recovery (Joachimsson et al, 1996; Ihnken et al, 1998). The aim of this study is to evaluate the impact of a peri-operative change in oxygen therapy management for cardiac surgical patients based on emerging evidence. The change involved the adoption of a conservative oxygen therapy approach to oxygen therapy management during the perio-operative period. Conservatiive oxygen therapy is involves the deliberate manipulation of fraction of inspired oxygen (FiO2) concentration to achieve normal blood oxygen saturations. We plan to inlcude 100 cardiac surgical patients in the before period and 100 cardiac surgical patients in the after period.

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