Fraction of inspired oxygen during general anesthesia for non-cardiac surgery: Systematic review and meta-analysis

Maria Høybye, Peter C Lind, Mathias J Holmberg, Maria Bolther, Marie K Jessen, Mikael F Vallentin, Frederik B Hansen, Johanne M Holst, Andreas Magnussen, Niklas S Hansen, Cecilie M Johannsen, Johannes Enevoldsen, Thomas H Jensen, Lara L Roessler, Maibritt P Klitholm, Mark A Eggertsen, Philip Caap, Caroline Boye, Karol M Dabrowski, Lasse Vormfenne, Jeppe Henriksen, Mathias Karlsson, Ida R Balleby, Marie S Rasmussen, Kim Paelestik, Asger Granfeldt, Lars W Andersen, Maria Høybye, Peter C Lind, Mathias J Holmberg, Maria Bolther, Marie K Jessen, Mikael F Vallentin, Frederik B Hansen, Johanne M Holst, Andreas Magnussen, Niklas S Hansen, Cecilie M Johannsen, Johannes Enevoldsen, Thomas H Jensen, Lara L Roessler, Maibritt P Klitholm, Mark A Eggertsen, Philip Caap, Caroline Boye, Karol M Dabrowski, Lasse Vormfenne, Jeppe Henriksen, Mathias Karlsson, Ida R Balleby, Marie S Rasmussen, Kim Paelestik, Asger Granfeldt, Lars W Andersen

Abstract

Background: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO2 ) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO2 on postoperative outcomes.

Methods: PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO2 levels in adults undergoing general anesthesia for non-cardiac surgery. Two investigators independently reviewed studies for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed for relevant outcomes, and potential effect measure modification was assessed in subgroup analyses and meta-regression. The evidence certainty was evaluated using GRADE.

Results: This review included 25 original trials investigating the effect of a high (mostly 80%) versus a low (mostly 30%) FiO2 . Risk of bias was intermediate for all trials. A high FiO2 did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81-1.02 [p = .10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90-1.79 [p = .18]) and hospital length of stay (mean difference = 0.03 days, 95% CI -0.25 to 0.30 [p = .84). Results from subgroup analyses and meta-regression did not identify any clear effect modifiers across outcomes. The certainty of evidence (GRADE) was rated as low for most outcomes.

Conclusions: In adults undergoing general anesthesia for non-cardiac surgery, a high FiO2 did not improve outcomes including surgical site infections, length of stay, or mortality. However, the certainty of the evidence was assessed as low.

Keywords: complications; fraction of inspired oxygen; general anesthesia; meta-analysis; outcomes; systematic review.

Conflict of interest statement

None of the authors have any conflict of interest.

© 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

Figures

FIGURE 1
FIGURE 1
Overview of results from meta‐analyses of binary outcomes. FiO2, fraction of inspired oxygen; CI, confidence interval.
FIGURE 2
FIGURE 2
Meta‐analysis for short‐term mortality. FiO2, Fraction of inspired oxygen; CI, confidence interval.
FIGURE 3
FIGURE 3
Meta‐analysis for surgical site infection. FiO2, Fraction of inspired oxygen; CI, confidence interval.

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