Episode 3: Announcements and FIO2 in one lung ventilation

There are a few announcements I wanted to make including:

Check out pedsanesthesia.net.  Dr. Robert Greenberg, a pediatric anesthesiologist here at Johns Hopkins runs it and it has lots of great information and topics in pediatric anesthesiology.

If you have suggestions for a better website than this one please let me know!

If you know a good way to set up an email list serve for these kinds of announcements please let me know that as well.

And, finally, I address a surgeon’s comment to one of our residents that you should always use 100% fio2 when ventilating one lung during a thoracic case.  Listen to the podcast for details but the bottom line is you should NOT use 100% oxygen unless you have to in order to prevent hypoxia.

Here is a link to a great review on this topics published last year in Critical Care: https://www.ncbi.nlm.nih.gov/pubmed/26278383

2 Replies to “Episode 3: Announcements and FIO2 in one lung ventilation”

  1. I am a PGY-1 anesthesia resident who is just beginning my training journey. I have been very interested in the use of oxygen in the perioperative period and would love your education and opinion. I understand the concepts of oxygen toxicity and reabsorption atelectasis. I have not seen a single study that verifies the clinical significance of this in the perioperative period. Most surgeries that we will be administered an anesthetic for will be well below the time period required to have clinically significant lung injury from 100% FiO2, and I have yet to find a study that supports any clinically significant reabsorptive atelectasis. The paper you linked to this episode has a small section addressing the perioperative period and it sites multiple benefits of hyperoxia in the perioperative period and gives a few papers with possible adverse outcomes in specific patient populations. One of my anesthesia mentors is a supporter of 100% oxygen in the OR. His reasoning is that we can drive up the PaO2 which provides a safety net for a patient to go up to 8-10 minutes without ventilation before they became hypoxic. What is your opinion on this? I would appreciate any thoughts you had about his topic, and I thank you very much for this podcast

    1. Hi Jordan,

      You are right, we don’t know the answer in any definitive way in the perioperative period. I do not, personally, run patients on 21% fio2. I usually use about 50%. Do you get a longer “buffer” period if you use 100%? Yes. In my experience, it is extremely rare to need it. We do know that you can measure increased reactive oxygen species after less than an hour on 100%, so it is having an effect. Is that effect clinically significant? We don’t know the answer to that. I don’t think patients need 100% and I think there may be harm, so I avoid it unless I think there’s real risk of losing the airway for some reason. But I can’t give you great evidence to take back to your attending and prove to them that they shouldn’t be using 100% for a few hours in the OR. I’d love to hear if others have anything to add.

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