• Choon-Hak Lim, Ju-Young Han, Seung-Ha Cha, Yun-Hee Kim, Kyung-Yeon Yoo, and Hyun-Jung Kim.
• Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, South Korea.
• J Clin Anesth. 2021 Dec 1; 75: 110461.

ObjectivesTo determine whether high perioperative inspired oxygen fraction (FiO2) compared with low FiO2 has more deleterious postoperative clinical outcomes in patients undergoing non-thoracic surgery under general anesthesia.DesignMeta-analysis of randomized controlled trials.SettingOperating room, postoperative recovery room and surgical ward.PatientsSurgical patients under general anesthesia.InterventionHigh perioperative FiO2 (≥0.8) vs. low FiO2 (≤0.5).MeasurementsThe primary outcome was mortality within 30 days. Secondary outcomes were pulmonary outcomes (atelectasis, pneumonia, respiratory failure, postoperative pulmonary complications [PPCs], and postoperative oxygen parameters), intensive care unit (ICU) admissions, and length of hospital stay. A subgroup analysis was performed to explore the treatment effect by body mass index (BMI).Main ResultsTwenty-six trials with a total 4991 patients were studied. The mortality in the high FiO2 group did not differ from that in the low FiO2 group (risk ratio [RR] 0.91, 95% confidence interval [CI] 0.42-1.97, P = 0.810). Nor were there any significant differences between the groups in such outcomes as pneumonia (RR 1.19, 95% CI 0.74-1.92, P = 0.470), respiratory failure (RR 1.29, 95% CI 0.82-2.04, P = 0.270), PPCs (RR 1.05, 95% CI 0.69-1.59, P = 0.830), ICU admission (RR 0.94, 95% CI 0.55-1.60, P = 0.810), and length of hospital stay (mean difference [MD] 0.27 d, 95% CI -0.28-0.81, P = 0.340). The high FiO2 was associated with postoperative atelectasis more often (risk ratio 1.27, 95% CI 1.00-1.62, P = 0.050), and lower postoperative arterial partial oxygen pressure (MD -5.03 mmHg, 95% CI -7.90- -2.16, P < 0.001). In subgroup analysis of BMI >30 kg/m2, these parameters were similarly affected between the groups.ConclusionsThe use of high FiO2 compared to low FiO2 did not affect the short-term mortality, although it may increase the incidence of atelectasis in adult, non-thoracic patients undergoing surgical procedures. Nor were there any significant differences in other secondary outcomes.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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