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

de Jonge, Stijn, Egger, Matthias, Latif, Asad, Loke, Yoon Kong, Berenholtz, Sean, Boermeester, Marja, Allegranzi, Benedetta and Solomkin, Joseph (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). pp. 325-334. ISSN 0007-0912

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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 Since then, further trials have been published, trials included previously have come under scrutiny, and one article was retracted.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.

Item Type: Article
Additional Information: doi: 10.1016/j.bja.2018.11.024
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: LivePure Connector
Date Deposited: 13 Feb 2019 11:30
Last Modified: 15 Jun 2020 23:56
URI: https://ueaeprints.uea.ac.uk/id/eprint/69917
DOI: 10.1016/j.bja.2018.11.024

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