Avoidance of Hyperoxemia Versus Routine Hyperoxia During Cardiopulmonary Bypass in Children With Cyanotic Congenital Heart Disease—A Systematic Review and Meta‐Analysis

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ABSTRACT Background Children with cyanotic congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass (CPB) are exposed to varying oxygenation strategies, and the optimal oxygenation strategy and the impact of limiting hyperoxic exposure remain uncertain. This study aimed to compare oxygenation strategies designed to avoid hyperoxemia versus routine hyperoxic management in this population. Methods A systematic search was conducted in four databases. The primary outcome was postoperative intubation time. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, total operative duration, and epinephrine requirement. Standardized mean difference (SMD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated for continuous and categorical outcomes, respectively. A random‐effects model was applied to all outcomes. Results Seven studies (six randomized controlled trials; one observational) met all the inclusion criteria. Strategies avoiding hyperoxemia did not significantly reduce postoperative intubation time compared with routine hyperoxia (SMD: −0.25; 95% CI: −0.52–0.03; p = 0.077; I 2 = 15%). Also, no significant differences were observed for ICU LOS (SMD: −0.04; 95% CI: −0.46–0.38; p = 0.859; I 2 = 64%), hospital LOS (SMD: 0.24; 95% CI: −0.01–0.50; p = 0.064; I 2 = 0%), operative duration (SMD: −0.66; 95% CI: −1.90–0.58; p = 0.294; I 2 = 84%), and epinephrine use (OR: 0.66; 95% CI: 0.28–1.57; p = 0.350; I 2 = 0%). Conclusions No significant differences in postoperative outcomes were observed between oxygenation strategies aimed at avoiding hyperoxemia and routine hyperoxic management during CPB.

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