Effectiveness of 80% vs 30-35% fraction of inspired oxygen in patients undergoing surgery: An updated systematic review and meta-analysis

Authors

Stijn de Jonge, University of Amsterdam, Netherlands
Matthias Egger, University of Bern, Switzerland
Asad Latif, Johns Hopkins University School of Medicine, United StatesFollow
Yoon Kong Loke, University of East Anglia, United Kingdom
Sean Berenholtz, Johns Hopkins Medicine, United States
Marja Boermeester, University of Amsterdam, Netherlands
Benedetta Allegranzi, World Health Organization, Switzerland
Joseph Solomkin, University of Cincinnati College of Medicine, United States

Document Type

Review Article

Department

Anaesthesia

Abstract

Background: In 2016, the World Health Organization (WHO) strongly recommended the use of a high fraction of inspired oxygen (FiO2) in adult patients undergoing general anaesthesia to reduce the risk of surgical site infection (SSI). Since then, further trials have been published, trials included previously have come under scrutiny, and one article was retracted. We updated the systematic review on which the recommendation was based.
Methods: We performed a systematic literature search from January 1990 to April 2018 for RCTs comparing the effect of high (80%) vs standard (30-35%) FiO2 on the incidence of SSI. Studies retracted or under investigation were excluded. A random effects model was used for meta-analyses; the sources of heterogeneity were explored using meta-regression.
Results: Of 21 RCTs included, six were newly identified since the publication of the WHO guideline review; 17 could be included in the final analyses. Overall, no evidence for a reduction of SSI after the use of high FiO2 was found [relative risk (RR): 0.89; 95% confidence interval (CI): 0.73-1.07]. There was evidence that high FiO2 was beneficial in intubated patients [RR: 0.80 (95% CI: 0.64-0.99)], but not in non-intubated patients [RR: 1.20 (95% CI: 0.91-1.58); test of interaction; P=0.048].
Conclusions: The WHO updated analyses did not show definite beneficial effect of the use of high perioperative FiO2, overall, but there was evidence of effect of reducing the SSI risk in surgical patients under general anaesthesia with tracheal intubation. However, the evidence for this beneficial effect has become weaker and the strength of the recommendation needs to be reconsidered.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

British Journal of Anaesthesia

Recommended Citation

de Jonge, S., Egger, M., Latif, A., Loke, Y. K., Berenholtz, S., Boermeester, M., Allegranzi, B., Solomkin, J. (2019). Effectiveness of 80% vs 30-35% fraction of inspired oxygen in patients undergoing surgery: An updated systematic review and meta-analysis. British Journal of Anaesthesia, 122(3), 325-334.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_anaesth/458