• Br J Anaesth · Jan 2020

    Randomized Controlled Trial Multicenter Study Comparative Study

    Effects of oxygen on post-surgical infections during an individualised perioperative open-lung ventilatory strategy: a randomised controlled trial.

    In the context of optimal, individualised lung ventilation, high inspired oxygen does not reduce surgical infections compared with conventional FiO2.

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    • Carlos Ferrando, César Aldecoa, Carmen Unzueta, F Javier Belda, Julián Librero, Gerardo Tusman, Fernando Suárez-Sipmann, Salvador Peiró, Natividad Pozo, Andrea Brunelli, Ignacio Garutti, Clara Gallego, Aurelio Rodríguez, Jose Ignacio García, Oscar Díaz-Cambronero, Jaume Balust, Francisco J Redondo, Manuel de la Matta, Lucía Gallego-Ligorit, Javier Hernández, Pascual Martínez, Ana Pérez, Sonsoles Leal, Enrique Alday, Pablo Monedero, Rafael González, Guido Mazzirani, Gerardo Aguilar, Manuel López-Baamonde, Mar Felipe, Ana Mugarra, Jara Torrente, Lucia Valencia, Viviana Varón, Sergio Sánchez, Benigno Rodríguez, Ana Martín, Inmaculada India, Gonzalo Azparren, Rodrigo Molina, Jesús Villar, Marina Soro, and iPROVE-O2 Network.
    • Department of Anesthesiology and Critical Care, Hospital Clínic i Provincial, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: cafeoranestesia@gmail.com.
    • Br J Anaesth. 2020 Jan 1; 124 (1): 110-120.

    BackgroundWe aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery.MethodsWe performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality.ResultsWe enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59-1.50; P=0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48-1.25; P=0.38) and myocardial ischaemia (0.6% [n=2] vs 0% [n=0]; P=0.47) did not differ between groups.ConclusionsAn oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found.Clinical Trial RegistrationNCT02776046.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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    In the context of optimal, individualised lung ventilation, high inspired oxygen does not reduce surgical infections compared with conventional FiO2.

    Daniel Jolley  Daniel Jolley
     
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