Risk factors for hypoxemia after coronary artery bypass grafting: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIANG Yuping ,  ZENG Ling , LUO Tianhui , HUANG Kaiqin

Department of Intensive Care Unit/West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

ZENG Ling, Email: zengling510@163.com

Keywords：

Coronary artery bypass grafting; hypoxemia; risk factor; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202001074

Video：

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Objective To systematically evaluate the risk factors for hypoxemia after coronary artery bypass grafting (CABG).Methods Eight electronic databases including PubMed, EMbase, CENTRAL, Web of Science, CNKI, CBM, VIP and Wanfang data were searched by computer to collect cochort and case-control studies about CABG and hypoxemia published from inception to March 2020. Two authors independently assessed the quality using the Newcastle-Ottawa Scale (NOS), and a meta-analysis was performed by RevMan 5.3 software.Results A total of 15 studies involving 4 277 patients were included in this study and among them 1 273 patients suffered hypoxemia. Meta-analysis showed that age (OR=1.55, 95%CI 1.22 to 1.96, P=0.000 3), smoking (OR=3.22, 95%CI 2.48 to 4.17, P<0.000 01), preoperative chronic pulmonary diseases (OR=4.75, 95%CI 3.28 to 6.86, P<0.000 01), diabetes (OR=2.49, 95%CI 1.86 to 3.33,P<0.000 01), left ventricular ejection fraction (OR=3.15, 95%CI 2.19 to 4.52, P<0.000 01), number of coronary artery lesions (OR=2.20, 95%CI 1.63 to 2.97, P<0.000 1) were independent risk factors for hypoxemia after CABG; body mass index (OR=1.31, 95%CI 0.97 to 1.77, P=0.08) and cardiopulmonary bypass time (OR=3.40, 95%CI 0.72 to 15.94, P=0.12) were not associated with hypoxemia.Conclusion Current evidence shows that age, preoperative chronic pulmonary diseases, smoking, diabetes, left ventricular ejection fraction, number of coronary artery are risk factors for hypoxemia after CABG, which can be used to identify high-risk patients and provide guidance for medical staff to develop perioperative preventive strategies to reduce the incidence of hypoxemia. The results should be validated by large-scale standard studies in the future.

Citation： XIANG Yuping, ZENG Ling, LUO Tianhui, HUANG Kaiqin. Risk factors for hypoxemia after coronary artery bypass grafting: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(8): 926-932. doi: 10.7507/1007-4848.202001074 Copy

1.	Stephens RS, Shah AS, Whitman GJ. Lung injury and acute respiratory distress syndrome after cardiac surgery. Ann Thorac Surg, 2013, 95(3): 1122-1129.
2.	Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118.
3.	Santos NP, Mitsunaga RM, Borges DL, et al. Factors associated to hypoxemia in patients undergoing coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2013, 28(3): 364-370.
4.	李连镇, 梅举, 何毅, 等. 非体外循环冠脉搭桥术后早期重度低氧血症的风险预测模型探索. 中国心血管病研究, 2017, 15(3): 227-230.
5.	Wang SP, Li M, Yi L, et al. The impact of early hypoxemia on the prognosis of patients undergone general anesthesia patients in intensive care unit. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2013, 25(10): 600-603.
6.	Liu TJ, Shih MS, Lee WL, et al. Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery. Ann Thorac Surg, 2013, 96(1): 127-132.
7.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
8.	Shi S, Gao Y, Wang L, et al. Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation. J Cardiothorac Surg, 2015, 10: 122.
9.	栗志勇, 常俊伟, 张悟麟, 等. 被动吸烟对冠状动脉搭桥术后低氧血症的影响. 医学研究与教育, 2018, 35(1): 31-36.
10.	Ji Q, Mei Y, Wang X, et al. Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Circ J, 2008, 72(12): 1975-1980.
11.	何军. 非体外循环下冠脉搭桥术后低氧血症的分析及治疗. 河北大学, 2017.
12.	郭炯. 非体外循环下冠状动脉搭桥术后低氧血症的危险因素分析及肺复张治疗. 郑州大学, 2018.
13.	沈亮, 陆晨希, 仲崇俊. 非体外循环下冠状动脉旁路移植术后低氧血症的危险因素分析. 解放军医学院学报, 2014, 35(1): 49-51, 91.
14.	张宪芬, 高文根, 张殿宝, 等. 冠脉搭桥术后低氧血症相关分析. 中国医药科学, 2015, 5(16): 139-141.
15.	冯靖, 季强, 梅运清, 等. 冠状动脉旁路移植术后低氧血症的相关因素分析. 同济大学学报: 医学版, 2012, 33(5): 53-57.
16.	沈立, 薛松, 汪永义. 冠状动脉旁路移植术后低氧血症危险因素研究. 中国心血管病研究, 2014, 12(2): 102-106.
17.	宋冀东, 闫继东. 老年冠状动脉旁路移植术后低氧血症的危险因素. 中国老年学杂志, 2015, 35(8): 2019-2021.
18.	许卫江, 陈祖君, 肖红艳, 等. 体外循环冠状动脉旁路移植术后低氧血症的危险因素分析. 中国综合临床, 2011, 27(3): 249-252.
19.	朱晓敏. 术前戒烟时间对择期冠脉搭桥患者术后低氧血症发生率的影响. 河南科技大学, 2015.
20.	程国栋, 朱春磊, 李小芳, 等. 37 例非体外循环冠状动脉搭桥术后低氧血症的危险因素分析. 临床医学, 2019, 39(10): 47-49.
21.	王贺之. 非体外循环冠状动脉旁路移植术后低氧血症相关因素分析. 河北医科大学, 2016.
22.	Xu F, Zhuang J, Wang R, et al. Blunted ventilatory response to hypoxia/hypercapnia in mice with cigarette smoke-induced emphysema. Respir Physiol Neurobiol, 2007, 158(1): 5-13.
23.	Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis, 2011, 6(6): 199-208.
24.	Xiong XQ, Wang WT, Wang LR, et al. Diabetes increases inflammation and lung injury associated with protective ventilation strategy in mice. Int Immunopharmacol, 2012, 13(3): 280-283.
25.	Hickson DA, Burchfiel CM, Liu J, et al. Diabetes, impaired glucose tolerance, and metabolic biomarkers in individuals with normal glucose tolerance are inversely associated with lung function: the Jackson Heart Study. Lung, 2011, 189(4): 311-321.
26.	Mirzaaghazadeh M, Bahtouee M, Mehdiniya F, et al. The relationship between nocturnal hypoxemia and left ventricular ejection fraction in congestive heart failure patients. Sleep Disord, 2014, 2014: 978358.

1. Stephens RS, Shah AS, Whitman GJ. Lung injury and acute respiratory distress syndrome after cardiac surgery. Ann Thorac Surg, 2013, 95(3): 1122-1129.
2. Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg, 2013, 8: 118.
3. Santos NP, Mitsunaga RM, Borges DL, et al. Factors associated to hypoxemia in patients undergoing coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2013, 28(3): 364-370.
4. 李连镇, 梅举, 何毅, 等. 非体外循环冠脉搭桥术后早期重度低氧血症的风险预测模型探索. 中国心血管病研究, 2017, 15(3): 227-230.
5. Wang SP, Li M, Yi L, et al. The impact of early hypoxemia on the prognosis of patients undergone general anesthesia patients in intensive care unit. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 2013, 25(10): 600-603.
6. Liu TJ, Shih MS, Lee WL, et al. Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery. Ann Thorac Surg, 2013, 96(1): 127-132.
7. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
8. Shi S, Gao Y, Wang L, et al. Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation. J Cardiothorac Surg, 2015, 10: 122.
9. 栗志勇, 常俊伟, 张悟麟, 等. 被动吸烟对冠状动脉搭桥术后低氧血症的影响. 医学研究与教育, 2018, 35(1): 31-36.
10. Ji Q, Mei Y, Wang X, et al. Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Circ J, 2008, 72(12): 1975-1980.
11. 何军. 非体外循环下冠脉搭桥术后低氧血症的分析及治疗. 河北大学, 2017.
12. 郭炯. 非体外循环下冠状动脉搭桥术后低氧血症的危险因素分析及肺复张治疗. 郑州大学, 2018.
13. 沈亮, 陆晨希, 仲崇俊. 非体外循环下冠状动脉旁路移植术后低氧血症的危险因素分析. 解放军医学院学报, 2014, 35(1): 49-51, 91.
14. 张宪芬, 高文根, 张殿宝, 等. 冠脉搭桥术后低氧血症相关分析. 中国医药科学, 2015, 5(16): 139-141.
15. 冯靖, 季强, 梅运清, 等. 冠状动脉旁路移植术后低氧血症的相关因素分析. 同济大学学报: 医学版, 2012, 33(5): 53-57.
16. 沈立, 薛松, 汪永义. 冠状动脉旁路移植术后低氧血症危险因素研究. 中国心血管病研究, 2014, 12(2): 102-106.
17. 宋冀东, 闫继东. 老年冠状动脉旁路移植术后低氧血症的危险因素. 中国老年学杂志, 2015, 35(8): 2019-2021.
18. 许卫江, 陈祖君, 肖红艳, 等. 体外循环冠状动脉旁路移植术后低氧血症的危险因素分析. 中国综合临床, 2011, 27(3): 249-252.
19. 朱晓敏. 术前戒烟时间对择期冠脉搭桥患者术后低氧血症发生率的影响. 河南科技大学, 2015.
20. 程国栋, 朱春磊, 李小芳, 等. 37 例非体外循环冠状动脉搭桥术后低氧血症的危险因素分析. 临床医学, 2019, 39(10): 47-49.
21. 王贺之. 非体外循环冠状动脉旁路移植术后低氧血症相关因素分析. 河北医科大学, 2016.
22. Xu F, Zhuang J, Wang R, et al. Blunted ventilatory response to hypoxia/hypercapnia in mice with cigarette smoke-induced emphysema. Respir Physiol Neurobiol, 2007, 158(1): 5-13.
23. Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis, 2011, 6(6): 199-208.
24. Xiong XQ, Wang WT, Wang LR, et al. Diabetes increases inflammation and lung injury associated with protective ventilation strategy in mice. Int Immunopharmacol, 2012, 13(3): 280-283.
25. Hickson DA, Burchfiel CM, Liu J, et al. Diabetes, impaired glucose tolerance, and metabolic biomarkers in individuals with normal glucose tolerance are inversely associated with lung function: the Jackson Heart Study. Lung, 2011, 189(4): 311-321.
26. Mirzaaghazadeh M, Bahtouee M, Mehdiniya F, et al. The relationship between nocturnal hypoxemia and left ventricular ejection fraction in congestive heart failure patients. Sleep Disord, 2014, 2014: 978358.

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Risk factors for hypoxemia after coronary artery bypass grafting: A systematic review and meta-analysis

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