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Effects of oxygen on post-surgical infections during an individualised perioperative open-lung ventilatory strategy: a randomised controlled trial.

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2019-11-22

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Ferrando, Carlos
Aldecoa, César
Unzueta, Carmen
Belda, F Javier
Librero, Julián
Tusman, Gerardo
Suárez-Sipmann, Fernando
Peiró, Salvador
Pozo, Natividad
Brunelli, Andrea

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Abstract

We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality. We enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59-1.50; P=0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48-1.25; P=0.38) and myocardial ischaemia (0.6% [n=2] vs 0% [n=0]; P=0.47) did not differ between groups. An oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found. NCT02776046.

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Abdomen
Adult
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Oxygen
Oxyhemoglobins
Perioperative Care
Positive-Pressure Respiration
Precision Medicine
Pulmonary Atelectasis
Respiration, Artificial
Surgical Wound Infection
Treatment Outcome

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Keywords

anaesthesia, inspiratory oxygen fraction, positive end-expiratory pressure, postoperative complications, recruitment manoeuvres, sepsis, surgery, surgical site infection

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