Supplemental oxygen and surgical-site infections: an alternating intervention controlled trial

Kurz, Andrea; Kopyeva, Tatyana; Suliman, Irina; Podolyak, Attila; You, Jing; Lewis, Brian D.; Vlah, Claudene; Khatib, Riad; Keebler, Allen; Reigert, R.; Seuffert, M.; Muzie, L.; Drahuschak, Sean; Görgün, Emre; Stocchi, Luca; Turan, Alparslan; Sessler, Daniel I.

doi:10.1016/j.bja.2017.11.003

Cited by 77 publications

(122 citation statements)

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“…In addition, the World Health Organization has recommended an FiO 2 of 80% or above to reduce surgical site infections, on the basis of mixed results from moderate quality trials 96979899. However, the use of a higher FiO 2 (>80%) can also cause resorption atelectasis and worsen inflammatory lung injury 27100.…”

Section: Additional Considerationsmentioning

confidence: 99%

Perioperative lung protective ventilation

O’Gara

Talmor

2018

BMJ

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Perioperative lung injury is a major source of postoperative morbidity, excess healthcare use, and avoidable mortality. Many potential inciting factors can lead to this condition, including intraoperative ventilator induced lung injury. Questions exist as to whether protective ventilation strategies used in the intensive care unit for patients with acute respiratory distress syndrome are equally beneficial for surgical patients, most of whom do not present with any pre-existing lung pathology. Studied both individually and in combination as a package of intraoperative lung protective ventilation, the use of low tidal volumes, moderate positive end expiratory pressure, and recruitment maneuvers have been shown to improve oxygenation and pulmonary physiology and to reduce postoperative pulmonary complications in at risk patient groups. Further work is needed to define the potential contributions of alternative ventilator strategies, limiting excessive intraoperative oxygen supplementation, use of non-invasive techniques in the postoperative period, and personalized mechanical ventilation. Although the weight of evidence strongly suggests a role for lung protective ventilation in moderate risk patient groups, definitive evidence of its benefit for the general surgical population does not exist. However, given the shift in understanding of what is needed for adequate oxygenation and ventilation under anesthesia, the largely historical arguments against the use of intraoperative lung protective ventilation may soon be outdated, on the basis of its expanding track record of safety and efficacy in multiple settings.

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Section: Additional Considerationsmentioning

confidence: 99%

Perioperative lung protective ventilation

O’Gara

Talmor

2018

BMJ

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“…On the other hand, the use of 100% FiO 2 at induction and emergence and subsequently limiting to 80% during maintenance is thought to increase the margin of safety for hypoxemia while decreasing the risk for postoperative nausea and vomiting (PONV) and surgical site infections (SSI). [8][9][10] Anaesthesiologists may thus decide to provide routine high FiO 2 without considering the potential adverse effects on lung function. The present double-blinded, randomized study sought to compare the perioperative outcomes for children subjected to anaesthesia and ventilated with high (80%) or low (35%) FiO 2 during maintenance of anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

“…values in the frequency range of 5 to 19 Hz (R[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] ), in which no systematic frequency dependence occurs. The AX, representing the stiffness of the respiratory tissues, was assessed by calculating the area under the reactance curve between 5…”

mentioning

confidence: 99%

“…Relationships of the baseline (M1) lung volume (FRC), ventilation heterogeneity (LCI), airway resistance (R[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] ) and respiratory tissue compliance (C rs ) data obtained in the present study (symbols) with the reference values from a similar patient population16,17 (dashed lines). Closed and open symbols depict data obtained from an individual child allocated to receive 80% FiO 2 (Group H) or 35% FiO 2 (Group L) during anaesthesia maintenance.…”

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confidence: 99%

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High inspired oxygen fraction impairs lung volume and ventilation heterogeneity in healthy children: a double-blind randomised controlled trial

Grandville

Peták

Albu

et al. 2019

British Journal of Anaesthesia

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Background: Although high inspired oxygen fraction (FiO 2) is common practice in pediatric anaesthesia, there is lack of evidence for affects on postoperative lung function. Therefore, we compared postoperative changes in lung volume, ventilation heterogeneity and respiratory mechanics while ventilating anaesthetised children with low or high FiO 2. Methods: In a double-blinded, randomized, controlled trial, children scheduled for elective surgery were randomly assigned 100% FiO 2 (Group H) or 80% FiO 2 (Group L) during anaesthesia induction and emergence, while anaesthesia was maintained with either FiO 2 of 80% (Group H) or 35% (Group L). During spontaneous breathing, we measured functional residual capacity (FRC) and lung clearance index (LCI) by multiple-breath nitrogen washout, airway resistance and respiratory tissue elastance by forced oscillations preoperatively (M1), after discharge from the recovery room (M2) and at day 1 postoperatively (M3). Secondary outcomes were the occurrence of respiratory complications, post-operative nausea and vomiting and surgical site infection at 30 days postoperatively. Results: FRC decreased in Group H at M2 (-14.7% [-21.0,-8.3] 95% CI, p=0.008) but normalized at M3. Ventilation inhomogeneity (LCI) increased in both groups at M2 but remained elevated only in Group H at M3 (6.3% [-0.3, 12.9%], p=0.023). No differences in respiratory mechanical parameters or in secondary outcomes were observed. Conclusions: High FiO 2 decreases lung volume in the immediate postoperative period with long-lasting enhancement in lung heterogeneity. This result, in addition to the wellestablished harmful effects of hyperoxia, supports the avoidance of high FiO 2 during anaesthesia management of children with normal lungs.

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“…9 More recent studies have failed to demonstrate a benefit of oxygen. 10 Hyperoxia has also been shown to improve anastomotic integrity in experimental animal models and in patients undergoing colorectal and gastric surgery, but study populations were very small and further research is required in this area. 2…”

Section: Postoperative Complicationsmentioning

confidence: 99%