Perioperative high inspired oxygen fraction induces atelectasis in patients undergoing abdominal surgery: A randomized controlled trial

Park, MiHye; Jung, Kangha; Sim, Woo Seog; Kim, Duk Kyung; Chung, In Sun; Choi, Ji Won; Lee, Eun Jee; Lee, Nam Young; Kim, Jie Ae

doi:10.1016/j.jclinane.2021.110285

Cited by 21 publications

(24 citation statements)

References 27 publications

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“…All but six trials compared an intraoperative FiO 2 of 80% to an intraoperative FiO 2 of 30%. Two trials investigated an intraoperative FiO 2 of 100% 45 or 50% 32 in the intervention arm, one trial an FiO 2 of 80% in the intervention arm and 40% in the control arm, 9 one trial an FiO 2 of 65% in the intervention arm and 35% in the control arm, 57 and finally two trials an FiO 2 of 33% 37 or 35% 29 FiO 2 in the control arm. Most of the trials were small (median sample size = 252) with only 32% ( n = 8) including 500 patients or more.…”

Section: Resultsmentioning

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: Resultsmentioning

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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“…22 While there are some referenced potential benefits to EEG based anesthetic depth monitoring in the surgical population 26 abdominal sugery, there are studies showing increased risk of mortality, increased cancer incidence, increased incidence of atelectasis, and increased cardiac injury markers with utilization of higher O 2 concentrations perioperatively. [33][34][35][36] There appears to be minimal evidence for higher O 2 concentrations contributing to an increased risk of surgical site infections. [37][38][39] From a resources standpoint, reducing the amount of oxygen needed per patient could lead to improved costs with reduced ventilator and ICU time in liver transplantation patients, with the caveat that data has been extrapolated.…”

Section: Discussionmentioning

confidence: 99%

“…However, the panel felt despite the lack of evidence, strong recommendations could be made in these specific domains based on established literature from other surgical arenas. Regarding the use of liberal versus restrictive O 2 use in abdominal sugery, there are studies showing increased risk of mortality, increased cancer incidence, increased incidence of atelectasis, and increased cardiac injury markers with utilization of higher O 2 concentrations perioperatively 33–36 . There appears to be minimal evidence for higher O 2 concentrations contributing to an increased risk of surgical site infections 37–39 .…”

Section: Discussionmentioning

confidence: 99%

Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

Chadha

Patel

Bhangui

et al. 2022

Clinical Transplantation

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“…Lung ultrasound is a non-invasive bedside tool with real-time imaging ability and without radiation, which is highly suitable for the examination of perioperative atelectasis [18]. In contrast to the clinical diagnosis of atelectasis, the sensitivity of atelectasis diagnosis using lung ultrasound can reach 100%, and mild atelectasis can be detected using lung ultrasound before the clinical manifestations appear [19,20]. Meanwhile, the accuracy of atelectasis diagnosis using lung ultrasound in both adults and children can exceed 88% [21,22].…”

Section: Introductionmentioning

confidence: 99%

The effects of laryngeal mask airway versus endotracheal tube on atelectasis in patients undergoing general anesthesia assessed by lung ultrasound: A protocol for a prospective, randomized controlled trial

Liu

Wang

et al. 2022

PLoS ONE

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Background The incidence of atelectasis is high in patients undergoing general anesthesia. This may cause oxygenation impairment and further contribute to postoperative pulmonary complications (PPCs). As important airway management devices for general anesthesia, few studies have compared the effects of laryngeal mask airway (LMA) and endotracheal tube (ETT) on atelectasis. Additionally, lung ultrasound has been increasingly used for bedside atelectasis diagnosis. For the above considerations, this trial is designed to compare the effects of LMA and ETT on atelectasis assessed by lung ultrasound scores, further providing more powerful clinical evidence for perioperative respiratory management of non-laparoscopic elective lower abdominal surgery under general anesthesia. Methods This is a prospective, single-center, single-blind, randomized controlled trial. From July 2021 to July 2022, 180 patients undergoing elective non-laparoscopic lower abdominal surgery under general anesthesia will be recruited and randomly divided into the ETT and LMA groups at a ratio of 1:1. The primary outcome is the total atelectasis LUS of 12 lung regions 15 min after the establishment of the artificial airway. The total atelectasis LUS at the end of surgery and 30 min after extubation, oxygenation index, postoperative airway complications, PPCs, and length of stay will be analyzed as secondary indicators. Trial registration ClinicalTrials.gov identifier: ChiCTR1900020818. Registered on January 20, 2019. Registered with the name of “Laryngeal mask airway versus endotracheal tube for atelectasis.” URL: https://www.chictr.org.cn/showproj.aspx?proj=35143.

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Perioperative high inspired oxygen fraction induces atelectasis in patients undergoing abdominal surgery: A randomized controlled trial

Cited by 21 publications

References 27 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

Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

The effects of laryngeal mask airway versus endotracheal tube on atelectasis in patients undergoing general anesthesia assessed by lung ultrasound: A protocol for a prospective, randomized controlled trial

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