The New World Health Organization Recommendations on Perioperative Administration of Oxygen to Prevent Surgical Site Infections: A Dangerous Reductionist Approach?

Abstract

In October 2016, the World Health Organization (WHO) published recommendations for preventing surgical site infections (SSIs). Among those measures is a recommendation to administer oxygen at an inspired fraction of 80% intra- and postoperatively for up to 6 hours. SSIs have been identified as a global health problem, and the WHO should be commended for their efforts. However, this recommendation focuses only on the patient's "wound," ignores other organ systems potentially affected by hyperoxia, and may ultimately worsen patient outcomes.The WHO advances a "strong recommendation" for the use of a high inspired oxygen fraction even though the quality of evidence is only moderate. However, achieving this goal by disregarding other potentially lethal complications seems inappropriate, particularly in light of the weak evidence underpinning the use of high fractions of oxygen to prevent SSI. Use of such a strategy thus should be intensely discussed by anesthesiologists and perioperative physicians.Normovolemia, normotension, normoglycemia, normothermia, and normoventilation can clearly be safely applied to most patients in most clinical scenarios. But the liberal application of hyperoxemia intraoperatively and up to 6 hours postoperatively, as suggested by the WHO, is questionable from the viewpoint of anesthesia and perioperative medicine, and its effects will be discussed in this article.

Surgical site infection surveillance following total knee arthroplasty: Tertiary care hospital experience

“…Surgical site infection may include purulent drainage from incision, positive fluid or tissue cultures on aseptically obtained samples, wound dehiscence or wound reopened by the surgeon in presence of fever, pain or tenderness, localized swelling, and redness. An abscess or other evidence of infection is found on direct examination, during reoperation, or by histopathology or radiologic evidence [ 8 ] , [ 9 ].…”

Perioperative Hyperoxyphobia: Justified or Not? Benefits and Harms of Hyperoxia during Surgery

“…The 2016 World Health Organisation guidelines on prevention of surgical site infections (SSI) recommended the use of a FiO 2 of 0.80 in intubated patients undergoing surgery [1]. This guideline, developed without the involvement of anaesthetists, added to the discussion and elicited several letters from around the world criticising its conclusions [2][3][4][5][6], especially when some of the trials demonstrating a positive effect on SSI were retracted or came under scrutiny [7][8][9][10]. Recently, the World Health Organisation updated its guidelines, (now also with the support of anaesthetists), based on a new systematic review excluding the questionable trials [11], and an independent review specifically focussing on potential adverse effects of hyperoxia [12].…”

Deletion of soluble epoxide hydrolase attenuates mice Hyperoxic acute lung injury

“…Hyperoxia is a very high topic in medicine [ 11 ]. Recently, the WHO recommended the use of high fraction of inspired oxygen for the prevention of surgical site infections [ 12 ]. However, the hyperoxia may be a double-edged sword.…”