Perioperative hyperoxia and myocardial injury after surgery: a randomized controlled trial.

Abstract

BACKGROUND:

The World Health Organization recommends hyperoxia (80% fraction of inspired oxygen, FiO2) during and for 2-6 hours following surgery to reduce surgical site infection (SSI). However, some studies suggest increased cardiovascular complications with such a high perioperative FiO2. The goal of our study was to compare the appearance of cardiovascular complications in elective adult colorectal surgery comparing the use of FiO2>0.8 versus conventional therapy (FiO2<0.4).

METHODS:

We performed a randomized controlled trial in intubated patients undergoing elective major colorectal surgery. Patients were randomly assigned to receive perioperative FiO2>0.8 or FiO2<0.4. The primary outcome, expressed as Odds Ratio (OR) ±95% Confidence Interval (95%CI), was the incidence of MINS (myocardial injury after noncardiac surgery evaluated for the first 4 postoperative days). Secondary outcomes included MACCE (major adverse cardiovascular and cerebral events) up to 30 postoperative days, SSI, other postoperative complications (according to Clavien-Dindo classification) and length of stay.

RESULTS:

We included in the final analyses 403 patients. Comparing the FiO2>0.8 and FiO2<0.4 groups, there was no difference in the appearance of MINS (6.0% vs. 10.4%; OR 0.55; 95% CI: 0.26-1.14; P=0.945). There were no differences between the groups for important secondary outcomes including MACCE to 30 days, SSI, postoperative complications or length of stay.

CONCLUSIONS:

Perioperative hyperoxia therapy (FiO2>0.8) with the aim of decreasing SSI did not increase cardiovascular complications after elective colorectal surgery in a general population.

• Authors: Marc Sadurni, Laura Castelltort, Pedro Rivera, Lluís Gallart, Marta Pascual, Xavier Duran, Mike P Grocott
• Journal: Minerva anestesiologica (Minerva Anestesiol) 2023 Jan-Feb Vol. 89 Issue 1-2 Pg. 40-47 ISSN: 1827-1596 [Electronic] Italy
• PMID: 36282221 (Publication Type: Randomized Controlled Trial, Journal Article)

Chemical References

• Oxygen

Topics

• Adult
• Humans
• Hyperoxia (epidemiology, complications)
• Surgical Wound Infection (epidemiology, chemically induced, complications)
• Oxygen
• Digestive System Surgical Procedures
• Elective Surgical Procedures (adverse effects)
• Postoperative Complications (epidemiology, prevention & control, chemically induced)