The peri‐operative management of surgical insertion and removal of the intravenous oxygenator device (IVOX): A report of nine cases

Abstract

Intravenous oxygenation (IVOX) is a new technique for augmentation of gas exchange in patients who require near maximal conventional ventilatory support. Patients who require IVOX are, by definition, critically ill with a high expected mortality. At present, these high risk patients must be transferred to the operating theatre for the IVOX device to be inserted. This report describes the anaesthetic problems associated with nine patients in whom an IVOX device was inserted and removed in our institution. The mortality was six out of nine patients; all deaths occurred with the IVOX device in situ. Three patients died within 6 h of insertion. Four patients were female. The patients' ages ranged from 14 to 76 years. There were few immediate ventilation changes in the first 4 h after IVOX insertion. Inspired oxygenation concentration was reduced in only one patient. Positive end‐expiratory pressure was not reduced. Peak inspiratory pressure decreased in four patients. Arterial oxygen tension increased in four patients (range 0.1–2.5 kPa) and decreased in five (range 0.1–3.4 kPa). Arterial carbon dioxide tension increased in one patient (0.3 kPa) and decreased in eight (range 0.1–2.7 kPa). Inotropic support with adrenaline, dobutamine and nor adrenaline needed to be initiated or increased in eight patients. Eight patients required 2–4 units of blood to be transfused during IVOX insertion or in the following 2 h. One patient suffered an asystolic cardiac arrest during the operation, but was resuscitated successfully. Three patients survived to have the IVOX removed. There were no cardiorespiratory problems associated with its removal and although all three required a vein patch to repair the venotomy site, no patient required blood transfusion. We conclude that IVOX insertion (including transfer to and from the operating theatre) represents a significant cardiorespiratory insult to these critically ill patients. Anaesthetic staff need to be aware of the potential problems to enable them to minimise the risk of serious complications during the insertion of this novel device. Copyright © 1993, Wiley Blackwell. All rights reserved