Evaluating oxygen reserve index-guided oxygenation for the prevention of postoperative delirium in elderly patients: a randomized controlled trial.
Summary
In a single-center RCT of 114 older adults, ORi-guided FiO2 titration reduced postoperative delirium from 42.1% to 12.3% and lowered intraoperative hyperoxemia and average FiO2. Noninvasive oxygen monitoring to avoid hyperoxemia may be a practical strategy to improve perioperative brain outcomes.
Key Findings
- ORi+SpO2-guided group had significantly lower POD incidence than control (12.3% vs 42.1%, P<0.001).
- Average intraoperative FiO2 was significantly lower with ORi guidance (P<0.001).
- Hyperoxemia episodes occurred less frequently in the ORi+SpO2 group.
Clinical Implications
Adopting ORi+SpO2-guided oxygen titration to avoid hyperoxemia may reduce postoperative delirium in older adults; anesthesia teams should consider lower FiO2 targets with real-time ORi monitoring when available.
Why It Matters
Demonstrates a modifiable intraoperative factor—hyperoxemia—linked to delirium and shows a feasible monitoring-based intervention with large effect size.
Limitations
- Single-center study with moderate sample size.
- Potential lack of blinding regarding oxygen titration could introduce performance bias.
Future Directions
Multicenter, blinded protocol RCTs to validate ORi-guided oxygenation on delirium and longer-term neurocognitive outcomes, with cost-effectiveness and implementation studies.
Study Information
- Study Type
- RCT
- Research Domain
- Prevention
- Evidence Level
- I - Randomized controlled trial providing high-level evidence.
- Study Design
- OTHER