• Anaesth Crit Care Pain Med · Dec 2020

    Review

    Effects of intraoperative high versus low inspiratory oxygen fraction (FiO2) on patient's outcome: A systematic review of evidence from the last 20 years.

    • Charlotte Fasquel, Olivier Huet, Yves Ozier, Christophe Quesnel, and Marc Garnier.
    • APHP Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Tenon, 75020 Paris, France; Centre Hospitalier Régional Universitaire de Brest, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 29200 Brest, France.
    • Anaesth Crit Care Pain Med. 2020 Dec 1; 39 (6): 847-858.

    AbstractDespite numerous studies, controversies about the best intraoperative FiO2 remain. In 2016, the World Health Organization (WHO) recommended that adult patients undergoing general anaesthesia should be ventilated intraoperatively with an 80% FiO2 to reduce surgical site infection (SSI). However, several data suggest that hyperoxia could have adverse effects. In order to determine the potential effect of FiO2 on SSI, we included in this systematic review 23 studies (among which 21 randomised controlled trials [RCT]) published between 1999 and 2020, comparing intraoperative high versus low FiO2. Results were heterogeneous but most recent studies on one hand, and the largest RCTs on the other hand, reported no difference on the incidence of SSI regarding intraoperative FiO2 during general anaesthesia. There was also no difference in the incidence of SSI depending of intraoperative FiO2 in patients receiving regional anaesthesia. The review on secondary endpoints (respiratory and cardiovascular adverse events, postoperative nausea and vomiting, postoperative length-of-stay and mortality) also failed to support the use of high FiO2. On the opposite, some data from follow-up analyses and registry studies suggested a possible negative effect of high intraoperative FiO2 on long-term outcomes. In conclusion, the systematic administration of a high intraoperative FiO2 in order to decrease SSI or improve other perioperative outcomes seems unjustified in the light of the evidence currently available in the literature.Copyright © 2020 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

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