Effects of oxygen on post-surgical infections during an individualised perioperative open-lung ventilatory strategy: a randomised controlled trial
Carlos Ferrando, César Aldecoa, Carmen Unzueta, F Javier Belda, Julián Librero, Gerardo Tusman, Fernando Suárez-Sipmann, Salvador Peiró, Natividad Pozo, Andrea Brunelli, Ignacio Garutti, Clara Gallego, Aurelio Rodríguez, Jose Ignacio García, Oscar Díaz-Cambronero, Jaume Balust, Francisco J Redondo, Manuel de la Matta, Lucía Gallego-Ligorit, Javier Hernández, Pascual Martínez, Ana Pérez, Sonsoles Leal, Enrique Alday, Pablo Monedero, Rafael González, Guido Mazzirani, Gerardo Aguilar, Manuel López-Baamonde, Mar Felipe, Ana Mugarra, Jara Torrente, Lucia Valencia, Viviana Varón, Sergio Sánchez, Benigno Rodríguez, Ana Martín, Inmaculada India, Gonzalo Azparren, Rodrigo Molina, Jesús Villar, Marina Soro, iPROVE-O2 Network, Jesús Acosta, María J Alberola, Amalia Alcón, Rosa Almajano, Carlos Álvarez, Rafael Anaya, Cristian Aragón, Marta Argilaga, Blanca Arocas, Begoña Ayas, Victor Balandrón, Elizabeth Bárcena, Natalia Bejarano, Luis Belmonte, Vanesa Berges, Maria Guillén Bermejo, Rafael Cabadas, Sergio Cabrera, Raquel Callejas, Jose Carbonell, Juan Carrizo, Jesús Castillo, Pedro Charco, Ana Colás, Lorena Colomina, Laura Cotter, Patricia Cruz, Javier Cuervo, Gema Del Castillo, Elena Del Río, Juan Delgado, Carlos Dexeus, Rubén Díaz, Mandalina Dinu, Alejandro Duca, Paula Duque, Gemma Echarri, Patricia Fabra, Carmen Fernández, Raluca Florea, Pilar Forcada, Isabel Fuentes, Cristina Garcés, Santiago G Del Valle, Beatriz García, Esther García, María García, Mercedes García, Beatriz Garrigues, Ignacio Garutti, Fernando Gil, Domingo González, Alejandro Gracia, Estefanía Gracia, Manuel Granell, Yessica Guerra, Andrea Gutierrez, Julia Hernando, Miriam Herrero, Maite Ibáñez, Inés Imaz, Blanca Izquierdo, Ana Jurado, Noelia Lafuente, Laura Lascorz, Irene León, Antonio López, Daniel López-Herrera, Angels Lozano, José M Marcos, Graciela Martínez, Sara Martínez, Esperanza Mata, Salomé Matoses, Rosa Mendez, María Merino, Andrés Millaruelo, Carlos R Molina, Berta Monleon, Omar M Montenegro, Ana Mugarra, Jose L Muñoz, Pablo Oliver-Forniés, Manuel Ortega, María A Palencia, Ana Parera, Ernesto Pastor, Maria Del Mar Pérez, Sara Pérez, David Pestaña, Santiago Piñol, Jaume Puig, Roger Pujol, Natividad Quesada, Ana Ramón, Consuelo Rego, Laura Reviriego, Rayco Rodríguez, Blanca Romero, Esther Romero, Marta Roselló, Lucas Rovira, Lola Ruiz, Laura Sancho, Francisco Sandín, Ferran Serralta, Eva Tres, Paola Valls, Laura Vaquero, Marina Varela, Victor Vega, Laura Viguera, Rubén Villazala, Abigail Villena, Sara Visiedo, Carlos Ferrando, César Aldecoa, Carmen Unzueta, F Javier Belda, Julián Librero, Gerardo Tusman, Fernando Suárez-Sipmann, Salvador Peiró, Natividad Pozo, Andrea Brunelli, Ignacio Garutti, Clara Gallego, Aurelio Rodríguez, Jose Ignacio García, Oscar Díaz-Cambronero, Jaume Balust, Francisco J Redondo, Manuel de la Matta, Lucía Gallego-Ligorit, Javier Hernández, Pascual Martínez, Ana Pérez, Sonsoles Leal, Enrique Alday, Pablo Monedero, Rafael González, Guido Mazzirani, Gerardo Aguilar, Manuel López-Baamonde, Mar Felipe, Ana Mugarra, Jara Torrente, Lucia Valencia, Viviana Varón, Sergio Sánchez, Benigno Rodríguez, Ana Martín, Inmaculada India, Gonzalo Azparren, Rodrigo Molina, Jesús Villar, Marina Soro, iPROVE-O2 Network, Jesús Acosta, María J Alberola, Amalia Alcón, Rosa Almajano, Carlos Álvarez, Rafael Anaya, Cristian Aragón, Marta Argilaga, Blanca Arocas, Begoña Ayas, Victor Balandrón, Elizabeth Bárcena, Natalia Bejarano, Luis Belmonte, Vanesa Berges, Maria Guillén Bermejo, Rafael Cabadas, Sergio Cabrera, Raquel Callejas, Jose Carbonell, Juan Carrizo, Jesús Castillo, Pedro Charco, Ana Colás, Lorena Colomina, Laura Cotter, Patricia Cruz, Javier Cuervo, Gema Del Castillo, Elena Del Río, Juan Delgado, Carlos Dexeus, Rubén Díaz, Mandalina Dinu, Alejandro Duca, Paula Duque, Gemma Echarri, Patricia Fabra, Carmen Fernández, Raluca Florea, Pilar Forcada, Isabel Fuentes, Cristina Garcés, Santiago G Del Valle, Beatriz García, Esther García, María García, Mercedes García, Beatriz Garrigues, Ignacio Garutti, Fernando Gil, Domingo González, Alejandro Gracia, Estefanía Gracia, Manuel Granell, Yessica Guerra, Andrea Gutierrez, Julia Hernando, Miriam Herrero, Maite Ibáñez, Inés Imaz, Blanca Izquierdo, Ana Jurado, Noelia Lafuente, Laura Lascorz, Irene León, Antonio López, Daniel López-Herrera, Angels Lozano, José M Marcos, Graciela Martínez, Sara Martínez, Esperanza Mata, Salomé Matoses, Rosa Mendez, María Merino, Andrés Millaruelo, Carlos R Molina, Berta Monleon, Omar M Montenegro, Ana Mugarra, Jose L Muñoz, Pablo Oliver-Forniés, Manuel Ortega, María A Palencia, Ana Parera, Ernesto Pastor, Maria Del Mar Pérez, Sara Pérez, David Pestaña, Santiago Piñol, Jaume Puig, Roger Pujol, Natividad Quesada, Ana Ramón, Consuelo Rego, Laura Reviriego, Rayco Rodríguez, Blanca Romero, Esther Romero, Marta Roselló, Lucas Rovira, Lola Ruiz, Laura Sancho, Francisco Sandín, Ferran Serralta, Eva Tres, Paola Valls, Laura Vaquero, Marina Varela, Victor Vega, Laura Viguera, Rubén Villazala, Abigail Villena, Sara Visiedo
Abstract
Background: 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.
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) 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.
Results: 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.
Conclusions: 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.
Clinical trial registration: NCT02776046.
Keywords: anaesthesia; inspiratory oxygen fraction; positive end-expiratory pressure; postoperative complications; recruitment manoeuvres; sepsis; surgery; surgical site infection.
Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
Source: PubMed