High inspired oxygen versus low inspired oxygen for reducing surgical site infection: a meta‐analysis

Abstract

To perform a meta-analysis of published literature to assess the role of high-concentration inspired oxygen in reducing the incidence of surgical site infections (SSIs) following all types of surgery, a comprehensive search for published randomized controlled trials (RCTs) comparing high- with low-concentration inspired oxygen for SSIs was performed. The related data were extracted by two independent authors. The fixed and random effects methods were used to combine data. Twelve RCTs involving 6750 patients were included. Our pooled result found that no significant difference in the incidence of SSIs was observed between the two groups, but there was high statistic heterogeneity across the studies [risk ratio (RR): 0·91; 95% confidence interval (CI): 0·72-1·14; P = 0·40; I = 54%]. The sensitivity analysis revealed the superiority of high-concentration oxygen in decreasing the SSI rate (RR: 0·86; 95% CI: 0·75-0·98; P = 0·02). Moreover, a subgroup analysis of studies with intestinal tract surgery showed that patients experienced less SSI when high-concentration inspired oxygen was administrated (RR: 0·53; 95% CI: 0·37-0·74; P = 0·0003). Our study provided no direct support for high-concentration inspired oxygen in reducing the incidence of SSIs in patients undergoing all types of surgery.

The Effect of Improving Basic Preventive Measures in the Perioperative Arena on Staphylococcus aureus Transmission and Surgical Site Infections

“…While most SSI prevention efforts have focused on host optimization and the inhibition of bacterial virulence, [9][10][11] a substantial body of evidence indicates the need for improved basic preventive measures. [12][13][14][15] A multimodal program targeting parallel improvements in hand hygiene, intravascular catheter disinfection, environmental cleaning, and patient decolonization is needed to address the complex interplay of intraoperative bacterial reservoirs.…”

“…Elevated intraoperative inspired oxygen was found to be ineffective for SSI prevention in a meta-analysis involving 12 randomized clinical trials. 11 Single interventions targeting improvements in intraoperative hand hygiene, 12 vascular care, 13 and patient decolonization 14 have reduced the incidence of SSIs. The bacterial inoculum has been linked by whole-cell genome analysis to 50% of Staphylococcus aureus SSIs.…”

“…The Surgical Care Improvement Project focused on host defenses and inhibition of bacterial virulence, with complete adherence predicting a decrease in postoperative infection rates. Elevated intraoperative inspired oxygen was found to be ineffective for SSI prevention in a meta-analysis involving 12 randomized clinical trials …”

The roles of noninvasive mechanical ventilation with helmet in patients with acute respiratory failure: A systematic review and meta-analysis

“…Analyses were conducted by using the statistical software Review Manager, version 5.1.0 (The Cochrane Collaboration, 2011). As we previously reported [16,17], for continuous variables, the mean difference (MD) with corresponding 95% confidence interval (CI) was calculated in inverse variance method. For dichotomous variables, the pooled risk ratio (RR) with corresponding 95% CI was aggregated in Mantel-Haenszel method.…”

Effect of Hyperoxygenation During Surgery on Surgical Site Infection in Colorectal Surgery

“…Our result showed that hyperoxygenation during surgery reduced the SSI rate, as well as the rate of anastomosis leakage. In this regard, some authors do not accept the effectiveness of supplemental oxygen [11, 20, 21], and some theories are used with respect to this controversy. The physiologic changes and interactions that occur after a substantial increase in the PaO 2 are multiple, complex, and difficult to study in vivo .…”