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Open Access

Effects of induced relative hypoxia during the postoperative period of abdominal oncologic surgery, on hemoglobin and reticulocyte levels: a prospective, randomized controlled clinical trial

  • M Khalife1,
  • K Wiams1,
  • M Ben Aziz1,
  • M Paesmans1,
  • C Balestra2 and
  • M Sosnowski1
Critical Care201216(Suppl 1):P262

https://doi.org/10.1186/cc10869

Published: 20 March 2012

Keywords

ErythropoietinReduce GlutathioneFree Oxygen RadicalOncologic PatientFree Oxygen

Introduction

Anemia is a frequent complication in oncologic patients. Erythropoietin (EPO) stimulating agents are known as alternatives to transfusion. However, they expose patients to thrombosis and are expensive. Recently, a new phenomenon, the normobaric oxygen paradox (NOP), has been described. In brief, transient hyperoxia followed by a prolonged return to normoxia acts as an effective trigger for EPO production. The mechanism depends on free oxygen radicals and on reduced glutathione (GSH) availabilities. Also, N-acetylcystein (NAC) is known to regenerate the stock of GSH. Very few clinical trials have investigated this phenomenon [1]. The goal of this study was to test the NOP theory on the evolution of hemoglobin and reticulocytes in patients receiving intermittent oxygen with or without NAC compared to a control group.

Methods

This prospective, randomized study included 78 patients (three groups). The first group (G1; n = 26) received 60% FiO2 for 2 consecutive hours on the first, third, and fifth days postoperatively. The second group (G2; n = 26) in addition to oxygen received NAC 200 mg/day for 5 days. The third group (G3; n = 26) was the control group which did not receive any oxygen variation. On postoperative day 6, hemoglobin, hematocrit and reticulocytes were measured and compared to the baseline values. A total of five patients (three in G1 and two in G2) were excluded for discontinuing oxygen and/or early discharge from hospital.

Results

The reticulocyte count in G1 showed statistically different values compared to G2 and G3. These findings correlate with other clinical trials [2]. The fact that no statistical difference of hemoglobin level was recorded could be attributed to the lack of follow-up after patient discharge (postoperative day 6). See Figure 1.

Conclusion

Induced relative hypoxia seems to be an effective stimulus for reticulocyte synthesis. However, further investigations are needed to confirm these findings and their impact on hemoglobin.

Authors’ Affiliations

(1)
Institut Jules Bordet, Brussels, Belgium
(2)
Divert Alert Network Europe Research Division, Brussels, Belgium

References

  1. Balestra C, et al.: J Appl Physiol. 2006, 100: 512-518. 10.1152/japplphysiol.00964.2005View ArticlePubMedGoogle Scholar
  2. Theunissen , et al.: Crit Care. 2011,15(Suppl 1):P422. 10.1186/cc9842PubMed CentralView ArticleGoogle Scholar

Copyright

© Khalife et al.; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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