Effects of oxygen on post-surgical infections during an individualised perioperative open-lung ventilatory strategy: a randomised controlled trial. (January 2020)

• Record Type: Journal Article
• Authors: Acosta, Jesús; Alberola, María J.; Alcón, Amalia; Almajano, Rosa; Álvarez, Carlos; Anaya, Rafael; Aragón, Cristian; Argilaga, Marta; Arocas, Blanca; Ayas, Begoña; Balandrón, Victor; Bárcena, Elizabeth; Bejarano, Natalia; Belmonte, Luis; Berges, Vanesa; Guillén Bermejo, Maria; Cabadas, Rafael; Cabrera, Sergio; Callejas, Raquel; Carbonell, Jose; Carrizo, Juan; Castillo, Jesús; Charco, Pedro; Colás, Ana; Colomina, Lorena; Cotter, Laura; Cruz, Patricia; Cuervo, Javier; Del Castillo, Gema; Del Río, Elena; Delgado, Juan; Dexeus, Carlos; Díaz, Rubén; Dinu, Mandalina; Duca, Alejandro; Duque, Paula; Echarri, Gemma; Fabra, Patricia; Fernández, Carmen; Florea, Raluca; Forcada, Pilar; Fuentes, Isabel; Garcés, Cristina; Del Valle, Santiago G.; García, Beatriz; García, Esther; García, María; García, Mercedes; Garrigues, Beatriz; Garutti, Ignacio; Gil, Fernando; González, Domingo; Gracia, Alejandro; Gracia, Estefanía; Granell, Manuel; Guerra, Yessica; Gutierrez, Andrea; Hernando, Julia; Herrero, Miriam; Ibáñez, Maite; Imaz, Inés; Izquierdo, Blanca; Jurado, Ana; Lafuente, Noelia; Lascorz, Laura; León, Irene; López, Antonio; López-Herrera, Daniel; Lozano, Angels; Marcos, José M.; Martínez, Graciela; Martínez, Sara; Mata, Esperanza; Matoses, Salomé; Mendez, Rosa; Merino, María; Millaruelo, Andrés; Molina, Carlos R.; Monleon, Berta; Montenegro, Omar M.; Mugarra, Ana; Muñoz, Jose L.; Oliver-Forniés, Pablo; Ortega, Manuel; Palencia, María A.; Parera, Ana; Pastor, Ernesto; del Mar Pérez, Maria; Pérez, Sara; Pestaña, David; Piñol, Santiago; Puig, Jaume; Pujol, Roger; Quesada, Natividad; Ramón, Ana; Rego, Consuelo; Reviriego, Laura; Rodríguez, Rayco; Romero, Blanca; Romero, Esther; Roselló, Marta; Rovira, Lucas; Ruiz, Lola; Sancho, Laura; Sandín, Francisco; Serralta, Ferran; Tres, Eva; Valls, Paola; Vaquero, Laura; Varela, Marina; Vega, Victor; Viguera, Laura; Villazala, Rubén; Villena, Abigail; Visiedo, Sara; Ferrando, Carlos; Aldecoa, César; Unzueta, Carmen; Belda, F. Javier; Librero, Julián; Tusman, Gerardo; Suárez-Sipmann, Fernando; Peiró, Salvador; Pozo, Natividad; Brunelli, Andrea; Garutti, Ignacio; Gallego, Clara; Rodríguez, Aurelio; García, Jose Ignacio; Díaz-Cambronero, Oscar; Balust, Jaume; Redondo, Francisco J.; de la Matta, Manuel; Gallego-Ligorit, Lucía; Hernández, Javier; Martínez, Pascual; Pérez, Ana; Leal, Sonsoles; Alday, Enrique; Monedero, Pablo; González, Rafael; Mazzirani, Guido; Aguilar, Gerardo; López-Baamonde, Manuel; Felipe, Mar; Mugarra, Ana; Torrente, Jara; Valencia, Lucia; Varón, Viviana; Sánchez, Sergio; Rodríguez, Benigno; Martín, Ana; India, Inmaculada; Azparren, Gonzalo; Molina, Rodrigo; Villar, Jesús; Soro, Marina;
• Is Part Of: British journal of anaesthesia. Volume 124:Number 1(2020)
• Page Start: 110
• Page End: 120
• Publication Date: 2020-01
• Subjects: anaesthesia -- inspiratory oxygen fraction -- positive end-expiratory pressure -- postoperative complications -- recruitment manoeuvres -- sepsis -- surgery -- surgical site infection; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2019.10.009
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: We aimed to examine whether using a high fraction of inspired oxygen ( F IO2 ) 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. Methods: 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) F IO2 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. Results: We enrolled 740 subjects: 371 in the high F IO2 group and 369 in the low F IO2 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%) F IO2 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. Conclusions: An oxygenation strategy using high F IO2 compared with conventional F IO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found. Clinical trial registration: NCT02776046.