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

Weenink, Robert P.; Jonge, Stijn De; Hulst, Rob A. van; Wingelaar, Thijs T.; Ooij, P. J. A. M. van; Immink, Rogier V.; Preckel, Benedikt; Hollmann, Markus W.

doi:10.3390/jcm9030642

Cited by 24 publications

(22 citation statements)

References 81 publications

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“…Thus, some controversy exists regarding "routine" supplemental oxygen administration following surgery. However, the clinical significance of such potentially harmful effects during the postoperative period has remained uncertain [23].…”

Section: Possible Harmful Effects Of Postoperative Hyperoxemic Oxygenmentioning

confidence: 99%

“…Additionally, follow-up studies of the PROXI trial [ 43 ], one of the largest RCTs with the lowest possible risk of bias and arguably the best designed trial conducted to date, found that 80% oxygen administration during the perioperative period was associated with significantly increased long-term mortality [ 44 ], shorter time to cancer recurrence or death [ 45 ], and long-term risk of myocardial infarction [ 46 ]. Thus, concerns regarding high FIO 2 and maintenance of hyperoxemia during and after surgery have still persisted [ 8 , 23 , 39 ].…”

Section: Prevention Of Surgical Site Infectionmentioning

confidence: 99%

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Oxygen administration for postoperative surgical patients: a narrative review

Suzuki

2020

j intensive care

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Most postoperative surgical patients routinely receive supplemental oxygen therapy to prevent the potential development of hypoxemia due to incomplete lung re-expansion, reduced chest wall, and diaphragmatic activity caused by surgical site pain, consequences of hemodynamic impairment, and residual effects of anesthetic drugs (most notably residual neuromuscular blockade), which may result in atelectasis, ventilation–perfusion mismatch, alveolar hypoventilation, and impaired upper airway patency. Additionally, the World Health Organization guidelines for reducing surgical site infection have recommended the perioperative administration of high-dose oxygen, including during the immediate postoperative period. However, supplemental oxygen and hyperoxemia also have harmful effects on the respiratory and cardiovascular systems, with several clinical studies having reported an association between high perioperative oxygen administration and worse clinical outcomes. Recently, the increased availability of new and short-acting anesthetic drugs, comprehensive pharmacological knowledge, postoperative multimodal analgesia, and new minimally invasive surgery options could result in lower incidences of postoperative hypoxemia. Moreover, recommendations promoting high oxygen administration to prevent surgical site infections have been challenged, considering the lack of scientific investigations, and have not been widely accepted. Given the potential harmful effects of hyperoxemia, routine postoperative oxygen administration might not be recommended. Recent clinical studies have indicated that a conservative approach to oxygen therapy, where oxygen administration is titrated to achieve slightly lower oxygen levels than usual, could be safely implemented and decrease acutely ill patients’ susceptibility to hyperoxemia. Based on current evidence, appropriate monitoring, including peripheral oxygen saturation, and oxygen titration should be required during postoperative oxygen administration to avoid both hypoxemia and hyperoxemia. Future trials should therefore focus on determining the optimal oxygen target during postoperative care.

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Section: Possible Harmful Effects Of Postoperative Hyperoxemic Oxygenmentioning

confidence: 99%

Section: Prevention Of Surgical Site Infectionmentioning

confidence: 99%

Oxygen administration for postoperative surgical patients: a narrative review

Suzuki

2020

j intensive care

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“…Perioperative hypothermia induces poor tissue perfusion, and several strategies have been proposed to avoid it, including preoperative or intraoperative warming [164,165]. A benefit of perioperative hyperoxia in non-critically ill adults has not been demonstrated [166].…”

Section: Intraoperative Care For Tja Patientsmentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

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“…Another very recently published paper still advocates hyperoxia in noncritically ill intubated adult surgical patients ( Weenink et al, 2020 ). The unclear risk-benefit ratio led Meyhoff and others to stress the need of large trials to obtain the required statistical power to evaluate the effects on SSIs ( Meyhoff et al, 2011 ; Cohen et al, 2018 ; Meyhoff, 2019 ).…”

Section: Therapeutic Strategies: Where Do We Stand and What Is The Fumentioning

confidence: 99%

Investigating Disturbances of Oxygen Homeostasis: From Cellular Mechanisms to the Clinical Practice

et al. 2020

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Soon after its discovery in the 18th century, oxygen was applied as a therapeutic agent to treat severely ill patients. Lack of oxygen, commonly termed as hypoxia, is frequently encountered in different disease states and is detrimental to human life. However, at the end of the 19th century, Paul Bert and James Lorrain Smith identified what is known as oxygen toxicity. The molecular basis of this phenomenon is oxygen’s readiness to accept electrons and to form different variants of aggressive radicals that interfere with normal cell functions. The human body has evolved to maintain oxygen homeostasis by different molecular systems that are either activated in the case of oxygen under-supply, or to scavenge and to transform oxygen radicals when excess amounts are encountered. Research has provided insights into cellular mechanisms of oxygen homeostasis and is still called upon in order to better understand related diseases. Oxygen therapy is one of the prime clinical interventions, as it is life saving, readily available, easy to apply and economically affordable. However, the current state of research also implicates a reconsidering of the liberal application of oxygen causing hyperoxia. Increasing evidence from preclinical and clinical studies suggest detrimental outcomes as a consequence of liberal oxygen therapy. In this review, we summarize concepts of cellular mechanisms regarding different forms of disturbed cellular oxygen homeostasis that may help to better define safe clinical application of oxygen therapy.

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

Cited by 24 publications

References 81 publications

Oxygen administration for postoperative surgical patients: a narrative review

Oxygen administration for postoperative surgical patients: a narrative review

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Investigating Disturbances of Oxygen Homeostasis: From Cellular Mechanisms to the Clinical Practice

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