Carlos Ferrando1, César Aldecoa2, Carmen Unzueta3, F Javier Belda4, Julián Librero5, Gerardo Tusman6, Fernando Suárez-Sipmann7, Salvador Peiró8, Natividad Pozo4, Andrea Brunelli9, Ignacio Garutti10, Clara Gallego11, Aurelio Rodríguez12, Jose Ignacio García13, Oscar Díaz-Cambronero14, Jaume Balust15, Francisco J Redondo16, Manuel de la Matta17, Lucía Gallego-Ligorit18, Javier Hernández19, Pascual Martínez20, Ana Pérez21, Sonsoles Leal22, Enrique Alday23, Pablo Monedero24, Rafael González25, Guido Mazzirani26, Gerardo Aguilar4, Manuel López-Baamonde15, Mar Felipe3, Ana Mugarra4, Jara Torrente27, Lucia Valencia12, Viviana Varón13, Sergio Sánchez16, Benigno Rodríguez22, Ana Martín25, Inmaculada India3, Gonzalo Azparren3, Rodrigo Molina13, Jesús Villar28, Marina Soro4. 1. 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. 2. Department of Anesthesiology and Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain. 3. Department of Anesthesiology and Critical Care, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain. 4. Department of Anesthesiology and Critical Care, Hospital Clínico Universitario, Valencia, Spain. 5. Navarrabiomed, Complejo Hospitalario de Navarra, UPNA, REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Valencia, Spain. 6. Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina. 7. CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University Hospital, Uppsala, Sweden; Department of Intensive Care, Hospital Universitario La Princesa, Madrid, Spain. 8. Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain. 9. Department of Anesthesiology and Critical Care, Hospital Germans Tries i Pujol, Badalona, Spain. 10. Department of Anesthesiology and Critical Care, Hospital Universitario General Gregorio Marañón, Madrid, Spain. 11. Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain. 12. Department of Anesthesiology and Critical Care, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain. 13. Department of Anesthesiology and Critical Care, Hospital Fundación of Alcorcón, Alcorcón, Spain. 14. Department of Anesthesiology and Critical Care, Hospital Universitario La Fe, Valencia, Spain. 15. Department of Anesthesiology and Critical Care, Hospital Clínic i Provincial, Barcelona, Spain. 16. Department of Anesthesiology and Critical Care, Hospital General de Ciudad Real, Ciudad Real, Spain. 17. Department of Anesthesiology and Critical Care, Hospital Universitario Virgen del Rocio, Sevilla, Spain. 18. Department of Anesthesiology and Critical Care, Hospital Universitario Miguel Servet, Zaragoza, Spain. 19. Department of Anesthesiology and Critical Care, Hospital General, Valencia, Spain. 20. Department of Anesthesiology and Critical Care, Hospital de Albacete, Albacete, Spain. 21. Department of Anesthesiology and Critical Care, Hospital of Elche, Elche, Spain. 22. Department of Anesthesiology and Critical Care, Hospital Povisa, Vigo, Spain. 23. Department of Anesthesiology and Critical Care, Hospital Universitario La Princesa, Madrid, Spain. 24. Department of Anesthesiology and Critical Care, Clínica Universitaria de Navarra, Pamplona, Spain. 25. Department of Anesthesiology and Critical Care, Hospital Universitario de León, León, Spain. 26. Department of Anesthesiology, Hospital de Manises, Manises, Spain. 27. Department of Intensive Care, Hospital Universitario La Princesa, Madrid, Spain. 28. CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain; Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St Michael''s Hospital, Toronto, ON, Canada.
Abstract
BACKGROUND: We 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. METHODS: We 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. RESULTS:We 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. CONCLUSIONS: An 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 REGISTRATION: NCT02776046.
RCT Entities:
BACKGROUND: We 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. METHODS: We 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. RESULTS: We 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. CONCLUSIONS: An 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 REGISTRATION: NCT02776046.
Authors: Mallory A Rowley; Kometh Thawanyarat; Jennifer K Shah; Lawrence Cai; Elizabeth Turner; Oscar J Manrique; Brian Thornton; Rahim Nazerali Journal: Aesthet Surg J Open Forum Date: 2022-05-07
Authors: Maria Høybye; Peter C Lind; Mathias J Holmberg; Maria Bolther; Marie K Jessen; Mikael F Vallentin; Frederik B Hansen; Johanne M Holst; Andreas Magnussen; Niklas S Hansen; Cecilie M Johannsen; Johannes Enevoldsen; Thomas H Jensen; Lara L Roessler; Maibritt P Klitholm; Mark A Eggertsen; Philip Caap; Caroline Boye; Karol M Dabrowski; Lasse Vormfenne; Jeppe Henriksen; Mathias Karlsson; Ida R Balleby; Marie S Rasmussen; Kim Paelestik; Asger Granfeldt; Lars W Andersen Journal: Acta Anaesthesiol Scand Date: 2022-06-23 Impact factor: 2.274