High-inspired 80% FiO₂ shows no safety compromise when compared with standard 30-35% FiO₂ among surgical patients.

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• Katharina Mattishent, Menaka Thavarajah, Ashnish Sinha, Adam Peel, Matthias Egger, Joseph Solomkin, Stijn de Jonge, Asad Latif, Sean Berenholtz, Benedetta Allegranzi, and Yoon Kong Loke.
• Norwich Medical School, University of East Anglia, Norwich, UK.
• Br J Anaesth. 2019 Mar 1; 122 (3): 311-324.

BackgroundEvidence-based guidelines from the World Health Organization (WHO) have recommended a high (80%) fraction of inspired oxygen (FiO2) to reduce surgical site infection in adult surgical patients undergoing general anaesthesia with tracheal intubation. However, there is ongoing debate over the safety of high FiO2. We performed a systematic review to define the relative risk of clinically relevant adverse events (AE) associated with high FiO2.MethodsWe reviewed potentially relevant articles from the WHO review supporting the recommendation, including an updated (July 2018) search of EMBASE and PubMed for randomised and non-randomised controlled studies reporting AE in surgical patients receiving 80% FiO2 compared with 30-35% FiO2. We assessed study quality and performed meta-analyses of risk ratios (RR) comparing 80% FiO2 against 30-35% for major complications, mortality, and intensive care admission.ResultsWe included 17 moderate-good quality trials and two non-randomised studies with serious-critical risk of bias. No evidence of harm with high FiO2 was found for major AE in the meta-analysis of randomised trials: atelectasis RR 0.91 [95% confidence interval (CI) 0.59-1.42); cardiovascular events RR 0.90 (95% CI 0.32-2.54); intensive care admission RR 0.93 (95% CI 0.7-1.12); and death during the trial RR 0.49 (95% CI 0.17-1.37). One non-randomised study reported that high FiO2 was associated with major respiratory AE [RR 1.99 (95% CI 1.72-2.31)].ConclusionsNo definite signal of harm with 80% FiO2 in adult surgical patients undergoing general anaesthesia was demonstrated and there is little evidence on safety-related issues to discourage its use in this population.Copyright © 2018 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

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