Perioperative oxygen fraction – effect on surgical site infection and pulmonary complications after abdominal surgery: a randomized clinical trial. Rationale and design of the PROXI-Trial

Meyhoff, Christian S.; Wetterslev, Jørn; Jørgensen, Lars N.; Henneberg, Steen Winther; Simonsen, Inger; Pulawska, Therese; Walker, Line R; Skovgaard, Nina; Heltø, Kim; Gocht-Jensen, Peter; Carlsson, P.; Rask, H; Karim, Sharaf; Carlsen, Charlotte Green; Jensen, Frank Svendsen; Rasmussen, Lars S.

doi:10.1186/1745-6215-9-58

Cited by 70 publications

(93 citation statements)

References 44 publications

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“…60,61 The potential beneficial impact of reducing the risk for surgical site infection (SSI) has been suggested, but likewise, this has not been proven conclusively. [62][63][64] Research suggests that supplementing the patient with oxygen could facilitate improved healing by enhancing bacterial killing and angiogenesis, reducing surgical site infection rates, and increasing wound tensile strength. 65 The independent role of increased F I O 2 on surgical site infection in clinical practice is not entirely clear, 66 but the studies conducted with a higher oxygen fraction (F I O 2 0.8) have not shown adverse effects on pulmonary function.…”

Section: Potential Beneficial Therapeutic Effects Associated With Higmentioning

confidence: 99%

Brief review: Theory and practice of minimal fresh gas flow anesthesia

Brattwall

Warrén-Stomberg

Hesselvik

et al. 2012

Can J Anesth/J Can Anesth

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Section: Potential Beneficial Therapeutic Effects Associated With Higmentioning

confidence: 99%

Brief review: Theory and practice of minimal fresh gas flow anesthesia

Brattwall

Warrén-Stomberg

Hesselvik

et al. 2012

Can J Anesth/J Can Anesth

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“…The authors suggest a number of cell-level mechanisms to explain this finding; nevertheless, the results have not since been replicated. Five other randomized trials have been reported in the literature, [36][37][38][39][40] and all but one 36 have shown equivalence.…”

Section: Hyperoxiamentioning

confidence: 99%

Review article: The anesthesiologist’s role in the prevention of surgical site infections

Forbes

McLean

2012

Can J Anesth/J Can Anesth

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Purpose To highlight the role of anesthesiologists in the prophylaxis of surgical site infections (SSIs) and to recognize the central role they play in quality improvement initiatives for the prevention of SSIs. Source The medical literature was searched with a focus on three interventions affecting the risk of SSIs: preoperative antibiotic administration, perioperative normothermia, and perioperative hyperoxia. The literature was also searched for examples of initiatives in patient safety and quality improvement that highlight the role of anesthesiologists in preventing SSIs. Principal findings The timely administration of preoperative antibiotics and the maintenance of perioperative normothermia have been shown to reduce the risk of SSI significantly. Perioperative hyperoxia in the prevention of SSIs remains controversial but may improve outcomes in specific subsets of the surgical population. Initiatives in quality improvement show the challenges faced by many centres to improve upon these processes of care, but they also highlight the role of anesthesiologists as champions in the multidisciplinary efforts for the prevention of SSIs. Conclusions Anesthesiologists are responsible for many of the processes of care shown to impact the risk for SSIs, and they play an important role in the prevention of SSIs.

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“…Notably, in the latter report the sample size was small and there was a difference in the baseline characteristics of the groups. A prospective trial randomizing patients to either 30% or 80% supplemental oxygen during and two hours after surgery, did not find any difference in several outcome measures including death, pulmonary complications and wound healing 64 . Of note, the administration of oxygen to the aged may be limited by the finding that although arterial oxygen tension did not decrease with age, there was reduced steady-state transfer of carbon monoxide in the lungs 65 .…”

Section: Iiia Oxygen Administrationmentioning

confidence: 99%

Anesthesia, Microcirculation, and Wound Repair in Aging

Bentov¹,

Reed²

2014

Survey of Anesthesiology

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Age related changes in skin contribute to impaired wound healing after surgical procedures. Changes in skin with age include decline in thickness and composition, a decrease in the number of most cell types and diminished microcirculation. The microcirculation provides tissue perfusion, fluid homeostasis, and delivery of oxygen and other nutrients. It also controls temperature and the inflammatory response. Surgical incisions cause further disruption of the microvasculature of aged skin. Perioperative management can be modified to minimize insults to aged tissues. Judicious use of fluids, maintenance of normal body temperature, pain control and increased tissue oxygen tension are examples of adjustable variables that support the microcirculation. Anesthetic agents influence the microcirculation from a combination of effects on cardiac output, arterial pressure and local micro-vascular changes. We examine the role of anesthetic management in optimizing the microcirculation and potentially improving postoperative wound repair in older persons. I. BackgroundSurgical wound repair is a major problem in the older population 1 , who are at increased risk of wound dehiscence and infection 2 . As a specific example, surgical site infections (SSI) are common (about 500,000 cases annually in the United States), lead to worse patient outcome (patients who develop SSI are twice as likely to die 3 ), and are an enormous economic burden (1-10 billion dollars annually) 4 . Many factors contribute to age related changes in skin 5 and subsequent vulnerability to impaired wound healing and infection. Changes in skin with age ( Figure 1) include a decline in epidermal and dermal thickness and composition, as well as a decrease in the number of most resident cell types. The dermalepidermal junction is flattened and the microcirculation is diminished 6 . The latter is defined as blood flow through arterioles, capillaries and venules and is the key system that affects the entire skin surface. In the aging patient, the skin's microcirculation is reduced by 40% between the ages of 20 to 70 years 7 . The microcirculation provides tissue perfusion, fluid hemostasis, and delivery of oxygen and other nutrients. It also controls temperature and the inflammatory response. Surgical incisions cause disruption of the skin's microcirculation as manifested by local edema resulting from vasodilation and increased vascular permeability. Summary StatementAged skin is at increased risk of poor post-operative wound healing. Changes in the cutaneous microcirculation with aging contribute to this risk. This review examines the role of anesthesia management on microcirculatory function. In this review, we will use skin as a representative organ to describe age-related changes that negatively affect the microcirculation and have subsequent impacts on wound healing and the incidence of postoperative infection. We will then examine the role of anesthesia management in minimizing detrimental effects on the microcirculation. A greater understanding of...

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Perioperative oxygen fraction – effect on surgical site infection and pulmonary complications after abdominal surgery: a randomized clinical trial. Rationale and design of the PROXI-Trial

Cited by 70 publications

References 44 publications

Brief review: Theory and practice of minimal fresh gas flow anesthesia

Brief review: Theory and practice of minimal fresh gas flow anesthesia

Review article: The anesthesiologist’s role in the prevention of surgical site infections

Anesthesia, Microcirculation, and Wound Repair in Aging

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