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CARDIOVASCULAR ANESTHESIOLOGY

Transdermal Oxygen Does Not Improve Sternal Wound Oxygenation in Patients Recovering from Cardiac Surgery

Mohamed H. Bakri, MD, PhD^*, Hassan Nagem, MD^*, Daniel I. Sessler, MD^*, Ramatia Mahboobi, MD^*, Jarrod Dalton, MA^*, Ozan Akça, MD, Eric E. Roselli, MD^||, and Steven R. Insler, DO^*¶

From the Departments of *Outcomes Research, Quantitative Health Sciences, ||Cardiothoracic Surgery, and ¶Cardiothoracic Anesthesia, The Cleveland Clinic, Cleveland, Ohio; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky; and Outcomes Research Consortium.

Address correspondence and reprint requests to Daniel I. Sessler, MD, Chair, Department of Outcomes Research, Cleveland Clinic Foundation, 9500 Euclid Ave.—P77, Cleveland, OH 44195. Address e-mail to DS{at}OR.org. On the world wide web: www.or.org.

Abstract

BACKGROUND: Sternal wound dehiscence and infection complicate 1% of cardiac surgeries. Tissue oxygen tension (PsqO₂) is the primary determinant of surgical wound infection risk and is often critically low in surgical incisions. We tested the hypothesis that local transdermal delivery of oxygen improves oxygenation in sternotomy wounds after cardiac surgery. Our secondary hypothesis was that supplemental inspired oxygen improves sternal wound PsqO₂.

METHODS: After undergoing cardiopulmonary bypass, 30 patients randomly received (1) 2 EpiFlo oxygen generators (Ogenix, Inc., Beachwood, OH) that provided oxygen at 6 mL/h into an occlusive wound dressing or (2) identical-appearing inactive generators. PsqO₂ and temperature were measured in the wound 5 mm below the skin surface. PsqO₂ and arterial oxygen (Pao₂) were measured 1 h after intensive care unit admission (Fio₂ = 60%) and on the first and second postoperative mornings at Fio₂ of both 30% and 50% in random order.

RESULTS: Data from four patients were excluded for technical reasons. Patient characteristics were similar in each group, as were type of surgery and perioperative management. Increasing Fio₂ from 30% to 50% improved Pao₂ from 99 [84–116] to 149 [128–174] mm Hg (P < 0.001, mean [95% CI]) and sternal wound PsqO₂ from 23 [16–33] to 27 [19–38] mm Hg (P < 0.001). In contrast, local oxygen delivery did not improve tissue oxygenation: 24 [14–41] vs 25 [16–41] mm Hg (P = 0.88).

CONCLUSIONS: Additional inspired oxygen improved Pao₂ and sternal wound PsqO₂ after bypass and may, consequently, reduce infection risk. However, oxygen insufflated locally into an occlusive dressing did not improve wound PsqO₂ and, therefore, does not appear to be useful clinically in cardiac surgery patients to reduce sternal wound infections.