Safety of 80% vs 30–35% fraction of inspired oxygen in patients undergoing surgery: a systematic review and meta-analysis (original) (raw)
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British Journal of Anaesthesia, 2019
Background: In 2016, the World Health Organization (WHO) strongly recommended the use of a high fraction of inspired oxygen (FiO 2) in adult patients undergoing general anaesthesia to reduce the risk of surgical site infection (SSI). Since then, further trials have been published, trials included previously have come under scrutiny, and one article was retracted. We updated the systematic review on which the recommendation was based. Methods: We performed a systematic literature search from January 1990 to April 2018 for RCTs comparing the effect of high (80%) vs standard (30e35%) FiO 2 on the incidence of SSI. Studies retracted or under investigation were excluded. A random effects model was used for meta-analyses; the sources of heterogeneity were explored using meta-regression. Results: Of 21 RCTs included, six were newly identified since the publication of the WHO guideline review; 17 could be included in the final analyses. Overall, no evidence for a reduction of SSI after the use of high FiO 2 was found [relative risk (RR): 0.89; 95% confidence interval (CI): 0.73e1.07]. There was evidence that high FiO 2 was beneficial in intubated patients [RR: 0.80 (95% CI: 0.64e0.99)], but not in non-intubated patients [RR: 1.20 (95% CI: 0.91e1.58); test of interaction; P¼0.048]. Conclusions: The WHO updated analyses did not show definite beneficial effect of the use of high perioperative FiO 2 , overall, but there was evidence of effect of reducing the SSI risk in surgical patients under general anaesthesia with tracheal intubation. However, the evidence for this beneficial effect has become weaker and the strength of the recommendation needs to be reconsidered.
Colombian Journal of Anesthesiology, 2012
To evaluate the effectiveness and safety of oxygen supplementation (inspired fraction of oxygen, FiO2) in high concentrations versus low concentrations, given with the aim of reducing complications in patients undergoing surgical procedures under general anesthesia. Methods: A systematic review and a meta-analysis were performed following the methodology proposed by the Cochrane Collaboration. The review included controlled clinical trials conducted in patients undergoing surgical procedures under general anesthesia. After conducting data base searches (PUBMED, CENTRAL y LILACS), and once the relevant studies were identified, additional snowballing ambispective and grey literature searches were done. Results: Of the 17 clinical trials finally included (4844 patients), 7 were considered to a have a low risk of bias. High FiO2 levels reduce post-operative nausea and vomiting only in surgeries with extensive intestinal manipulation (odds ratio [OR] 0.40; 95% confidence interval [CI] , 0.20 to 0.80). In this same clinical setting, the risk of surgical site infection (OR 0.46; 95% CI, 0.29 to 0.74), and mortality (OR 0.17; 95% CI, 0.03 to 0.99) are also reduced. There was no impact on the need for rescue anti-emetic administration, length of stay in the post-anesthetic care unit, unexpected admission to the intensive care unit, or postoperative hospital stay in any of the surgical populations. Conclusions: Intra-operative oxygen supplementation in high concentrations (≥ 60%) might reduce the risk of surgical site infection and mortality in surgeries with extensive intestinal manipulation
Anesthesiology, 2013
Background:Intraoperative high inspired oxygen fraction (Fio2) is thought to reduce the incidence of surgical site infection (SSI) and postoperative nausea and vomiting, and to promote postoperative atelectasis.Methods:The authors searched for randomized trials (till September 2012) comparing intraoperative high with normal Fio2 in adults undergoing surgery with general anesthesia and reporting on SSI, nausea or vomiting, or pulmonary outcomes.Results:The authors included 22 trials (7,001 patients) published in 26 reports. High Fio2 ranged from 80 to 100% (median, 80%); normal Fio2 ranged from 30 to 40% (median, 30%). In nine trials (5,103 patients, most received prophylactic antibiotics), the incidence of SSI decreased from 14.1% with normal Fio2 to 11.4% with high Fio2; risk ratio, 0.77 (95% CI, 0.59–1.00). After colorectal surgery, the incidence of SSI decreased from 19.3 to 15.2%; risk ratio, 0.78 (95% CI, 0.60–1.02). In 11 trials (2,293 patients), the incidence of nausea decrea...
British Journal of Anaesthesia, 2019
Background: We aimed to examine whether using a high fraction of inspired oxygen (FIO 2) in the context of an individualised intra-and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. Methods: We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO 2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality. Results: We enrolled 740 subjects: 371 in the high FIO 2 group and 369 in the low FIO 2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO 2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59e1.50; P¼0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48e1.25; P¼0.38) and myocardial ischaemia (0.6% [n¼2] vs 0% [n¼0]; P¼0.47) did not differ between groups. Conclusions: An oxygenation strategy using high FIO 2 compared with conventional FIO 2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found. Clinical trial registration: NCT02776046.
Anesthesia & Analgesia, 2008
BACKGROUND: Studies on the ability of supplemental oxygen to decrease the incidence of postoperative nausea and vomiting (PONV) are inconsistent, with initial studies suggesting benefit while subsequent trials demonstrate no decrease in PONV. METHODS: To clarify whether supplemental oxygen is an effective and reliable method to reduce PONV, we performed a systematic review (MEDLINE, Cochrane Library, hand searching and bibliographies, with no language restriction, through March 2006) of randomized, controlled trials comparing perioperative 80% versus 30%-40% Fio 2 on the incidence of PONV. For this systematic review, PONV was defined as any nausea, retching, and/or vomiting in the first 24 h after surgery. The end-points were early PONV (0 -6 h), late PONV (6 -24 h), and overall PONV (0 -24 h). Data from 10 trials with 1729 patients were included in our meta-analysis: 860 received 80% Fio 2 and 869 received 30%-40% Fio 2 . RESULTS: In patients who received 80% Fio 2 ,the relative risk (95% confidence intervals) of experiencing early PONV was 0.91 [0.71-1.16]; late PONV, 0.88 [0.69 -1.11]; and overall PONV, 0.91 [0.77-1.06]. Results were similar for early, late, and overall nausea and vomiting. CONCLUSIONS: The positive results of two initial studies reducing the risk for PONV in patients given 80% Fio 2 were not confirmed by any of the subsequent trials. Considering all available evidence, 80% Fio 2 should no longer be considered an effective or reliable method to reduce overall PONV.
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2002
Purpose One hundred percent O2 is used routinely for preoxy-genation and induction of anesthesia. The higher the O2 concentration the faster is the development of atelectasis, an important cause of impaired pulmonary gas exchange during general anesthesia (GA). We evaluated the effect of ventilation with 0.4FiO2 in air, 0.4FiO2 in N2O and 100% O2 following intubation on the development of impaired gas exchange. Methods Twenty-seven patients aged 18–40 yr, undergoing elective laparoscopic cholecystectomy were administered 100% O2 for preoxygenation (three minutes) and ventilation by mask (two minutes). Following intubation these patients were randomly divided into three groups of nine each and ventilated either with 0.4FiO2 in air, 0.4FiO2 in N2O or 100% O2. Arterial blood gases were obtained before preoxygenation and 30 min following intubation for PaO2 analysis. Subsequently PaO2/FiO2 ratios were calculated. Results were analyzed with Student’s t test and one-way ANOVA. P value of ≤ 0.05 was considered significant. Results Ventilation of the lungs with O2 in air (FiO2 0.4) significantly improved the PaO2/FiO2 ratio from baseline, while 0.4FiO2 in N2O or 100% O2 worsened the ratio (558 ± 47vs 472 ± 28, 365 ± 34vs 472 ± 22 and 351 ± 23 vs 477 ± 28 respectively; P < 0.05). Conclusion Ventilation of lungs with O2 in air (FiO2 0.4) improves gas exchange in young healthy patients during GA. Objectif Cent pour cent d’O2 sont utilisés habituellement pour la préoxygénation et l’induction de l’anesthésie. Plus la concentration d’O2 est élevée, plus vite peut se développer l’atélectasie, une cause importante d’anomalie des échanges gazeux pulmonaires pendant l’anesthésie générale (AG). Nous avons évalué l’effet de la ventilation avec uneFiO2 de 0,4 dans de l’air,FiO2 de 0,4 dans du N2O et 100 % d’O2 après l’intubation quand apparaissent les anomalie des échanges gazeux. Méthode Vingt-sept patients de 18–40 ans, devant subir une cholé-cystectomie laparoscopique non urgente ont reçu 100 % d’O2 pour la préoxygénation, pendant trois minutes, et la ventilation au masque, pendant deux minutes. Après l’intubation, ces patients ont été répartis de façon aléatoire en trois groupes de neuf et ventilés avec 0,4FiO2 dans de l’air ou 0,4FiO2 dans du N2O ou 100% d’O2. La gazométrie du sang artériel a été obtenue pendant la préoxygénation et 30 min après l’intubation pour l’analyse de la PaO2. Par la suite, les ratios PaO2/FiO2 ont été calculés. Les résultats ont été analysés selon le test t de Student et une analyse de variance à une voie. Une valeur de P ≤ 0,05 a été considérée comme significative. Résultats La ventilation pulmonaire avec de l’O2 dans de l’air (FiO2 de 0,4) a sensiblement amélioré le ratio PaO2/FiO2, comparativement aux données de base, tandis que 0,4FiO2 dans du N2O ou 100 % d’O2 l’ont altéré (558 ± 47vs 472 ± 28, 365 ± 34 vs 472 ± 22 et 351 ± 23 vs 477 ± 28 respectivement; P < 0,05). Conclusion La ventilation pulmonaire avec de l’O2 dans de l’air (FiO2 0,4) améliore les échanges gazeux chez les jeunes patients pendant l’AG.
BMC Research Notes, 2012
Background: A high perioperative inspiratory oxygen fraction (FiO 2 ) may reduce the frequency of surgical site infection. Perioperative atelectasis is caused by absorption, compression and reduced function of surfactant. It is well accepted, that ventilation with 100% oxygen for only a few minutes is associated with significant formation of atelectasis. However, it is still not clear if a longer period of 80% oxygen results in more atelectasis compared to a low FiO 2 . Our aim was to assess if a high FiO 2 is associated with impaired oxygenation and decreased pulmonary functional residual capacity (FRC).
Fio2 and acute respiratory distress syndrome definition during lung protective ventilation*
Critical Care Medicine, 2009
Objective: PaO 2 /FIO 2 ratio (P/F) is the marker of hypoxemia used in the American-European Consensus Conference on lung injury. A high F I O 2 level has been reported to variably alter PaO 2 /FIO 2 . We investigated the effect of high FIO 2 levels on the course of P/F in lung protective mechanically ventilated patients with acute respiratory distress syndrome.