Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complications After Abdominal Surgery

Meyhoff, Christian S.; Wetterslev, Jørn; Jørgensen, Lars N.; Henneberg, Steen Winther; Høgdall, Claus; Lundvall, Lene; Svendsen, Poul-Erik; Mollerup, Hannah; Lunn, Troels Haxholdt; Simonsen, Inger; Martinsen, Kristian R; Pulawska, Therese; Bundgaard, Lars; Bugge, Lasse; Hansen, Estrid Stæhr; Riber, Claus; Gocht-Jensen, Peter; Walker, Line R; Bendtsen, Asger; Johansson, Gun; Skovgaard, Nina; Heltø, Kim; Poukinski, Andrei; Korshin, André; Walli, Aqil; Bulut, Mustafa; Carlsson, P.; Rodt, S. Å.; Lundbech, Liselotte B; Rask, H; Buch, Niels; Perdawid, Sharafaden Karim; Reza, Joan Anwar; Jensen, Kirsten V; Carlsen, Charlotte Green; Jensen, Frank Svendsen; Rasmussen, Lars S.

doi:10.1001/jama.2009.1452

Cited by 369 publications

(259 citation statements)

References 31 publications

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“…35 The frequency of atelectasis among the patients in the PROXI Trial was 8% versus 7% in the 80% and 30% oxygen groups, respectively, and 6% in both the 80% and the 30% oxygen groups experienced pneumonia. 10 Another subgroup study of the PROXI Trial involving 35 patients showed no significant difference in change in oxygenation index or functional residual capacity when 80% oxygen was administered than when 30% oxygen was used. 36 Less evidence of the effect of ventilation with high oxygen is available in obese patients, but morbidly obese patients are more prone to perioperative atelectasis formation, and the atelectasis remains unresolved for a longer period after surgery than occurs in nonobese patients.…”

Section: Discussionmentioning

confidence: 98%

“…8,9 However, the PROXI Trial, involving 1,400 patients, recently showed no significant reduction in the frequency of SSI. 10 The arterial oxygen tension is reduced more in obese than in lean patients during general anesthesia as a consequence of atelectasis and increased shunt fraction. 1,11 Moreover, obesity increases the size of individual fat cells without increasing blood flow, 12 resulting in subnormal total blood flow in relation to body weight 13 and relatively hypoperfused fat tissue, 11 but cardiac output, circulating blood volume, and resting oxygen consumption are increased.…”

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confidence: 99%

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Inspiratory Oxygen Fraction and Postoperative Complications in Obese Patients

Staehr

Meyhoff²,

Rasmussen

2011

Anesthesiology

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Background:Obese patients are at a high risk of postoperative complication, including surgical site infection (SSI). Our aim was to evaluate the effect of a high inspiratory oxygen fraction (80%) on SSI and pulmonary complications in obese patients undergoing laparotomy. Methods: This study was a planned analysis of the obese patients (body mass index Ն 30 kg/m 2 ) recruited in the Danish multicenter, patient-and observer-blinded, PROXI Trial of 1,400 patients undergoing acute or elective laparotomy. Patients were randomized to receive either 80% or 30% oxygen during and for 2 h after surgery. The primary outcome was SSI within 14 days. Secondary outcomes were atelectasis, pneumonia, and respiratory failure. Results: Two hundred thirteen patients had a body mass index Ն 30 kg/m 2 . The median (5-95% range) body mass index was 34 kg/m 2 (30 -44) and 33 kg/m 2 (30 -41) in patients allocated to the 80% and 30% oxygen group. SSI occurred in 32 of 102 (31%) versus 29 of 111 (26%) patients given 80% and 30% oxygen, respectively (odds ratio, 1.29; 95% CI, 0.71-2.34; P ϭ 0.40). In addition, the incidence of

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

Inspiratory Oxygen Fraction and Postoperative Complications in Obese Patients

Staehr

Meyhoff²,

Rasmussen

2011

Anesthesiology

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“…But none of these attempted to look at the pulmonary complications due to perioperative hyperoxia, like increased risk of airway inflammation and poor regulation of blood glucose levels or oxidative stress [22,23]. The PROXI Randomized Control Trial, led by Meyhoff et al [7], observed that there was an increase in atelectasis (7.9 versus 7.1 %) and respiratory failure (5.5 versus 4.4 %) in the group of patients who received 80 % oxygen supplementation compared to 30 %. Considering these aspects, our study was designed at fixed 60 % oxygen supplementation.…”

Section: Discussionmentioning

confidence: 99%

“…Although higher concentrations of oxygen supplementation (80 %) were found to reduce SSI by half, inspiring a higher concentration of oxygen is not devoid of complications [5,6]. It can induce lung injury and atelectasis in patients at risk [7][8][9][10]. As evidence regarding the rational use of hyperoxia in the perioperative period in reducing SSI is very less, hence this study was planned with an objective of assessing the efficacy of supplementing oxygen at 60 % concentration perioperatively in reducing SSI.…”

Section: Introductionmentioning

confidence: 99%

Rational Hyperoxia in the Perioperative Period: a Safe and Effective Tool in the Reduction of SSI

et al. 2015

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Oxygen supplemented at a concentration higher than 40-50 % for at least 2 h perioperatively is expected to reduce surgical site infections (SSI). Although supplementation of 80 % of oxygen perioperatively has shown to reduce SSI in various studies, this concentration is known to be associated with airway complications. This study was taken up to assess the efficacy of 60 %, i.e. <80 and >50 %, inspired oxygen supplemented perioperatively in reducing SSI. One hundred and eighty-eight patients who underwent elective class I and II surgeries were studied. Patients were divided equally into two groups and subgroups and matched for age, sex, type of surgeries, etc. The control group received 30 % and the study group received 60 % oxygen supplementation perioperatively for 2 h. Wounds were observed for the development of SSI. 8/94 patients in the study group and 13/94 patients in the control group developed SSI (p<0.01). The results indicate a relative risk of 1.62, risk difference of 0.0531 and attributable risk of 38.42 %. Hence, it may be concluded that perioperative oxygen supplementation at 60 % concentration reduces SSI.

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“…In patients undergoing major surgery in whom normal wound perfusion is maintained, provision of high inspired oxygen (80%) intraoperatively and for a few hours after surgery significantly reduces the risk of SSI by 25-50%, 4,9 -12 although a more recent study found no difference. 13 A single study demonstrating reduced SSI with maintenance of intraoperative normothermia 5 rapidly changed practice. Guidelines for preventing SSI incorporated normothermia within 3 yr, 14 and pay-for-performance measures 15 did soon after.…”

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High Intraoperative Inspired Oxygen Does Not Increase Postoperative Supplemental Oxygen Requirements

Mackintosh¹,

Gertsch

Hopf

et al. 2012

Anesthesiology

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Background: Although a high fraction of inspired oxygen (FIO 2 ) could reduce surgical site infection, there is concern it could increase postoperative pulmonary complications, including hypoxemia. Intraoperative positive end-expiratory pressure can improve postoperative pulmonary function. A practical measure of postoperative pulmonary function and the degree of hypoxemia is supplemental oxygen requirement. We performed a double-blind randomized 2 ϫ 2 factorial study on the effects of intraoperative FIO 2 0.3 versus more than 0.9 with and without positive end-expiratory pressure on the primary outcome of postoperative supplemental oxygen requirements in patients undergoing lower risk surgery. Methods: After Institutional Review Board approval and consent, 100 subjects were randomized using computer-generated lists into four treatment groups (intraoperative FIO 2 0.3 vs. more than 0.9, with and without 3-5 cm H 2 O positive end-expiratory pressure). Thirty minutes and 24 h after extubation, supplemental oxygen was discontinued. Arterial

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Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complications After Abdominal Surgery

Cited by 369 publications

References 31 publications

Inspiratory Oxygen Fraction and Postoperative Complications in Obese Patients

Inspiratory Oxygen Fraction and Postoperative Complications in Obese Patients

Rational Hyperoxia in the Perioperative Period: a Safe and Effective Tool in the Reduction of SSI

High Intraoperative Inspired Oxygen Does Not Increase Postoperative Supplemental Oxygen Requirements

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