• Xue-Fei Li, Dan Jiang, Yu-Lian Jiang, Hong Yu, Meng-Qiu Zhang, Jia-Li Jiang, Lei-Lei He, and Hai Yu.
• Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu 610041, China.
• J Clin Anesth. 2020 Dec 1; 67: 110009.

Study ObjectiveIntraoperative lung-protective ventilation strategy has been recommended to reduce postoperative pulmonary complications (PPCs). However, the role of inspiratory oxygen fraction (FiO2) in this protection remains highly uncertain. We aimed to evaluate the effect of intraoperative low (30%) versus high (80%) FiO2 in the context of lung-protective ventilation strategy on PPCs in patients undergoing abdominal surgery.DesignProspective, two-arm, randomized controlled trial.SettingTertiary university hospital in China.PatientsA total of ASA I-III 252 patients aged ≥18, who were scheduled for elective abdominal surgery under general anesthesia were included in the study.InterventionPatients were randomly assigned to receive either 30% or 80% FiO2 during the intraoperative period. All patients received volume-controlled mechanical ventilation with lung-protective ventilation approach, which included a tidal volume of 8 ml kg-1 of predicted body weight, a positive end-expiratory pressure level of 6-8 cmH2O, and repeated recruitment maneuvers.MeasurementsThe primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, consisting of respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, and aspiration pneumonitis. The severity grade of PPCs was measured as a key secondary outcome.Main ResultsTwo hundred and fifty-one patients completed the trial. PPCs occurred in 43 of 125 (34.4%) patients assigned to receive 30% FiO2 compared with 59 of 126 (46.8%) patients receiving 80% FiO2 (relative risk 0.74, 97.5% confidence interval, 0.51-1.02, p = 0.045, > 0.025). The severity of PPCs within the first 7 days following surgery was attenuated significantly in the low (30%) FiO2 group (p = 0.001).ConclusionsAmong patients undergoing abdominal surgery under general anesthesia, an intraoperative lung-protective ventilation strategy with 30% FiO2 compared with 80% FiO2 did not reduce the incidence of PPCs. And the use of 30% FiO2 resulted in less severe pulmonary complications.Copyright © 2020 Elsevier Inc. All rights reserved.

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