Effects of intraoperative high versus low inspiratory oxygen fraction (FiO2) on patient's outcome: A systematic review of evidence from the last 20 years

Fasquel, Charlotte; Huet, Olivier; Ozier, Yves; Quesnel, Christophe; Garnier, Marc

doi:10.1016/j.accpm.2020.07.019

Cited by 11 publications

(4 citation statements)

References 90 publications

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“…5,6 Thus, some uncertainty remains regarding this balance of beneficial versus deleterious effects, and it might depend on certain patient and surgical characteristics. Although there are recent systematic reviews on this topic, 7,8 there are new trials to consider, 9,10 and these previous reviews have not extensively explored the potential effect heterogeneity between trials.…”

Section: Introductionmentioning

confidence: 99%

Fraction of inspired oxygen during general anesthesia for non‐cardiac surgery: Systematic review and meta‐analysis

Høybye

Lind

Holmberg

et al. 2022

Acta Anaesthesiol Scand

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Background: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO 2 ) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO 2 on postoperative outcomes.Methods: PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO 2 levels in adults undergoing general anesthesia for non-cardiac surgery. Two investigators independently reviewed studies for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed for relevant outcomes, and potential effect measure modification was assessed in subgroup analyses and meta-regression. The evidence certainty was evaluated using GRADE.Results: This review included 25 original trials investigating the effect of a high (mostly 80%) versus a low (mostly 30%) FiO 2 . Risk of bias was intermediate for all trials. A high FiO 2 did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81-1.02 [p = .10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90-1.79 [p = .18]) and hospital length of stay (mean difference = 0.03 days, 95% CI À0.25 to 0.30 [p = .84). Results from subgroup analyses and meta-regression did not identify any clear effect modifiers across outcomes. The certainty of evidence (GRADE) was rated as low for most outcomes.Maria Høybye and Peter C. Lind contributed equally.

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Section: Introductionmentioning

confidence: 99%

Fraction of inspired oxygen during general anesthesia for non‐cardiac surgery: Systematic review and meta‐analysis

Høybye

Lind

Holmberg

et al. 2022

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

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“…High oxygen tension is beneficial for reducing surgical site infection and in 2016 World Health Organization recommended that adults receive F I O 2 0.8 during mechanical ventilation under general anesthesia [ 1 ]. However, a more recent systematic review found no difference in the surgical site infection rate according to the intraoperative F I O 2 amount, and suggested a negative effect of high F I O 2 on long-term outcomes [ 2 ]. Other investigators did not find any difference in the degree of myocardial injury between perioperative F I O 2 0.3 and 0.8, and suggested that F I O 2 0.8 is safe for major non-cardiac surgery [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The relationship between the F I O 2 level and myocardial injury has not been well studied in patients undergoing TAVI. In this study, we investigated the effects of low (0.3) and high (0.8) F I O 2 , using the most widely studied fractions to compare different clinical impact of low vs. high oxygen contents [ 2 ], during transfemoral TAVI under general anesthesia on post-procedural myocardial injury, as indexed by serum cardiac troponin in the early post-TAVI period.…”

Section: Introductionmentioning

confidence: 99%

Effects of low versus high inspired oxygen fraction on myocardial injury after transcatheter aortic valve implantation: A randomized clinical trial

et al. 2023

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Background Oxygen therapy is used in various clinical situation, but its clinical outcomes are inconsistent. The relationship between the fraction of inspired oxygen (FIO2) during transcatheter aortic valve implantation (TAVI) and clinical outcomes has not been well studied. We investigated the association of FIO2 (low vs. high) and myocardial injury in patients undergoing TAVI. Methods Adults undergoing transfemoral TAVI under general anesthesia were randomly assigned to receive FIO2 0.3 or 0.8 during procedure. The primary outcome was the area under the curve (AUC) for high-sensitivity cardiac troponin I (hs-cTnI) during the first 72 h following TAVI. Secondary outcomes included the AUC for postprocedural creatine kinase-myocardial band (CK-MB), acute kidney injury and recovery, conduction abnormalities, pacemaker implantation, stroke, myocardial infarction, and in-hospital mortality. Results Between October 2017 and April 2022, 72 patients were randomized and 62 were included in the final analysis (n = 31 per group). The median (IQR) AUC for hs-cTnI in the first 72 h was 42.66 (24.82–65.44) and 71.96 (35.38–116.34) h·ng/mL in the FIO2 0.3 and 0.8 groups, respectively (p = 0.066). The AUC for CK-MB in the first 72 h was 257.6 (155.6–322.0) and 342.2 (195.4–485.2) h·ng/mL in the FIO2 0.3 and 0.8 groups, respectively (p = 0.132). Acute kidney recovery, defined as an increase in the estimated glomerular filtration rate ≥ 25% of baseline in 48 h, was more common in the FIO2 0.3 group (65% vs. 39%, p = 0.042). Other clinical outcomes were comparable between the groups. Conclusions The FIO2 level did not have a significant effect on periprocedural myocardial injury following TAVI. However, considering the marginal results, a benefit of low FIO2 during TAVI could not be ruled out.

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“…The causes of SSI are multifactorial involves length of hospital stay, patient co-morbidities, obesity, duration and complexity of surgical procedure, administration of general anesthesia, and a higher wound contamination classification [14,15]. The CDC classifies surgical wounds based on their level of contamination, beginning from the Clean class 1 which are non-infective wounds with no inflammation to Dirty class 4, which are old traumatic wounds containing devitalized tissue with clinical infection or perforated viscera [16].…”

Section: Introductionmentioning

confidence: 99%

Untitled

2023

J Surg Care

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Background: Multidrug-resistant (MDR) infections are a threat in patients undergoing surgery. This study was undertaken to determine the prevalence and possible predictors of MDR infections over a two-year period in patients with surgical site infection (SSI) at a tertiary care hospital in Riyadh, Saudi Arabia. Methods: We conducted a cross-sectional study from April 2016 to April 2018 by reviewing hospital records of patients with a diagnosis of SSI based on a physician report and laboratory findings. The isolation of MDR organisms (MDRO) from SSI was the primary outcome variable as well as other risk factors.Results: SSI was diagnosed in 55 out of 77 patients under study, with MDRO prevalence rate of 44%. Previous antibiotic use and hospitalization in the last 90 days were strongly associated with developing MDRO infection often due to ESBL producing Gram-negative bacterial pathogens. Superficial and deep incisional SSI were more frequent in patients compared to organ/space SSI. History of diabetes mellitus, duration of surgery and bacterial colonization at other body site also increased the likelihood of MDRO. Factors such as trauma, obesity, general anesthesia, and wound types were not found to increase the risk for MDRO. Conclusions: Our study identified recent antibiotic use and hospitalization as major risk factors for MDRO surgical site infections. Other predisposing factors include diabetes mellitus, duration of surgery and bacterial colonization. MDRO isolated include E. coli and Pseudomonas aeruginosa. Bacterial pathogens harboring multiple resistant mechanisms can complicate SSI adversely affecting clinical outcomes following routine surgical procedures.

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Effects of intraoperative high versus low inspiratory oxygen fraction (FiO2) on patient's outcome: A systematic review of evidence from the last 20 years

Cited by 11 publications

References 90 publications

Fraction of inspired oxygen during general anesthesia for non‐cardiac surgery: Systematic review and meta‐analysis

Fraction of inspired oxygen during general anesthesia for non‐cardiac surgery: Systematic review and meta‐analysis

Effects of low versus high inspired oxygen fraction on myocardial injury after transcatheter aortic valve implantation: A randomized clinical trial

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