Supplemental peri-operative oxygen and incision site infection after surgery for perforated peptic ulcer: A randomized, double-blind monocentric trial

Schietroma M, Cecilia EM, De Santis G, Carlei F, Pessia B, Amicucci G

"Supplemental 80% FiO2 during and for 6?h after open surgery for PPU, which reduces post-operative SSI, should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost."

Effects of supplemental oxygen and dexamethasone on surgical site infection: A factorial randomized trial

Kurz A, Fleischmann E, Sessler DI, Buggy DJ, Apfel C, Akça O; Factorial Trial Investigators

"Supplemental oxygen did not reduce surgical site infection risk. The preponderance of clinical evidence suggests that administration of 80% supplemental inspired oxygen does not reduce infection risk. We did not observe an increased risk of surgical site infection with the use of a single low dose of dexamethasone, indicating that it can be used for nausea and vomiting prophylaxis without promoting wound infections."

The effects of high perioperative inspiratory oxygen fraction for adult surgical patients

Wetterslev J, Meyhoff CS, Jørgensen LN, Gluud C, Lindschou J, Rasmussen LS

"As the risk of adverse events, including mortality, may be increased by a fraction of inspired oxygen of 60% or higher, and as robust evidence is lacking for a beneficial effect of a fraction of inspired oxygen of 60% or higher on surgical site infection, our overall results suggest that evidence is insufficient to support the routine use of a high fraction of inspired oxygen during anaesthesia and surgery. Given the risk of attrition and outcome reporting bias, as well as other weaknesses in the available evidence, further randomized clinical trials with low risk of bias in all bias domains, including a large sample size and long-term follow-up, are warranted."

Perioperative supplemental oxygen to reduce surgical site infection after open fixation of high-risk fractures: A randomized controlled pilot trial

Stall A, Paryavi E, Gupta R, Zadnik M, Hui E, O'Toole RV

"Use of a high concentration of FIO2 during the perioperative period is safe and shows a trend toward reduction of surgical site infection in patients undergoing open operative fixation of high-energy traumatic lower-extremity fractures. Further study in a larger patient population is indicated."

Leukocyte DNA Damage and Wound Infection after Nitrous Oxide Administration: A Randomized Controlled Trial

Chen Y, Liu X, Cheng CH, Gin T, Leslie K, Myles P, Chan MT

A double-blind, randomized, controlled trial randomized 91 patients undergoing major colorectal surgery to receive 70% nitrous oxide (n=31) or nitrous oxide-free anesthesia using 30 (n=30) or 80% (n=30) oxygen to investigate the extent of DNA damage while also recording postoperative wound infection rates. Results showed that the proportions of wound infection were 19.4% in the 70% nitrous oxide group and 6.7% in both the 30 and 80% oxygen groups. The study concluded that nitrous oxide increased DNA damage compared with nitrous oxide-free anesthesia and was associated with postoperative surgical site infection rates.

Intraoperative tissue oxygenation and postoperative outcomes after major non-cardiac surgery: An observational study

Abdelmalak BB, Cata JP, Bonilla A, You J, Kopyeva T, Vogel JD, Campbell S, Sessler DI

"Minimum perioperative peripheral tissue oxygenation predicted a composite of major complications and mortality from major non-cardiac surgery. This is an observational association and whether clinical interventions to augment tissue oxygenation will improve outcomes remains to be determined."

Effect of Perioperative Oxygen Supplementation on 30-day Surgical Site Infection Rate in Abdominal, Gynecologic, and Breast Surgery: The ISO2 Randomized Controlled Trial

Thibon P, Borgey F, Boutreux S, Hanouz JL, Le Coutour X, Parienti JJ

A controlled, randomized, assessor-blind multicenter trial including 434 patients undergoing abdominal, gynecologic and breast surgery (208 receiving 30% perioperative oxygen and 226 receiving 80%) compared the effects of hyperoxygenation (80% fraction of inspired oxygen) with those of 30% oxygen on the frequency of surgical site infections. The routine use of hyperoxygenation throughout abdominal, gynecologic, and breast surgery had no effect on the frequency of 30-day surgical site infections and was not accompanied by more frequent adverse effects.

Peri-Operative Oxygen and the Risk of Surgical Infection

Fakhry SM, Montgomery SC

A review examined seven randomized, controlled studies of increased peri-operative oxygenation during and shortly after general anesthesia as a means of reducing SSI. Given the divergent results of this relatively large number of randomized studies, no definitive consensus has emerged. At present, clinicians should proceed with caution, and the administration of greater amounts of supplemental oxygen probably should be restricted to well-designed and -conducted clinical trials.

The Role of Perioperative High Inspired Oxygen Therapy in Reducing Surgical Site Infection: A Meta-Analysis

Togioka B, Galvagno S, Sumida S, Murphy J, Ouanes JP, Wu C

A meta-analysis including a total of 2,728 patients (1,358 randomly assigned to hyperoxia and 1,370 to control) determined whether perioperative hyperoxia reduces surgical site infection. Perioperative high inspired oxygen therapy overall was not found to be beneficial for preventing surgical site infection based on this meta-analysis. Additional studies are needed to further investigate this intervention.

Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complications After Abdominal Surgery: The PROXI Randomized Clinical Trial

Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Høgdall C, Lundvall L, Svendsen PE, Mollerup H, Lunn TH, Simonsen I, Martinsen KR, Pulawska T, Bundgaard L, Bugge L, Hansen EG, Riber C, Gocht-Jensen P, Walker LR, Bendtsen A, Johansson G, Skovgaard N, Heltø K, Poukinski A, Korshin A, Walli A, Bulut M, Carlsson PS, Rodt SA, Lundbech LB, Rask H, Buch N, Perdawid SK, Reza J, Jensen KV, Carlsen CG, Jensen FS, Rasmussen LS

A patient- and observer-blinded randomized clinical trial of 1,400 patients undergoing abdominal surgery resulted in no difference in risk of surgical site infection with the administration of 80% or 30% oxygen.

Intraoperative Fraction of Inspired Oxygen Is a Modifiable Risk Factor for Surgical Site Infection after Spinal Surgery

Maragakis LL, Cosgrove SE, Martinez EA, Tucker MG, Cohen DB, Perl TM

A case-control study compared medical records of 104 patients with surgical site infection (SSI) after spinal surgery to 104 patients without SSI after spinal surgery. The study identified intraoperative adminstered fraction of inspired oxygen of less than 50% as an independent, modifiable risk factor for SSI after spinal surgery.

Hyperoxia and infection

Hopf HW, Holm J

This article reviewed the basic science underlying observations, along with the clinical data that support the use of hyperoxia in preventing and treating infections.

High-Concentration Supplemental Perioperative Oxygen to Reduce the Incidence of Postcesarean Surgical Site Infection: A Randomized Controlled Trial

Gardella C, Goltra LB, Laschansky E, Drolette L, Magaret A, Chadwick HS, Eschenbach D

A double blind study including 143 women undergoing Cesarean delivery (69 received high-concentration inspired oxygen, 74 received low-concentration inspired oxygen) found that high-concentration perioperative oxygen delivered through a nonrebreathing mask did not decrease the risk of postcesarean surgical site infection.

Canadian Association of General Surgeons and American College of Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 21. The risk of surgical site infection is reduced with perioperative oxygen

Brasel K, McRitchie D, Dellinger P; For the Canadian Association of General Surgeons and American College of Surgeon's Evidence Based Reviews in Surgery Group

A randomized, controlled trial of 300 patients undergoing elective colorectal resectional surgery showed a significant reduction in the risk of surgical site infection with the use of supplemental oxygen.

Optimal perioperative oxygen administration

Kabon B, Kurz A

A review provides an overview of the benefits and risks of perioperative supplemental oxygen administration. Supplemental oxygen administration during the perioperative period might be a simple, inexpensive and well-tolerated treatment option to improve patient outcome. The optimal inspired oxygen concentration still needs to be evaluated.

Supplemental Perioperative Oxygen and the Risk of Surgical Wound Infection: A Randomized Controlled Trial

Belda FJ, Aguilera L, Garcia de la Asunción J, Alberti J, Vicente R, Ferrándiz L, Rodríguez R, Company R, Sessler DI, Aguilar G, Botello SG, Ortí R; For the Spanish Reduccion de la Tasa de Infeccion Quirurgica Group

A double-blind, randomized controlled trial of 300 patients undergoing elective colorectal surgery suggested that supplemental oxygen is an effective intervention to reduce surgical site infection.

Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection

Greif R, Akça O, Horn EP, Kurz A, Sessler DI; For the Outcomes Research Group

Five hundred patients undergoing colorectal resection were randomly assigned to receive 30 percent or 80 percent oxygen perioperatively. It was determined that administration of supplemental oxygen was a practical method to reduce the incidence of surgical-wound infections.

Nitrous Oxide


Avoidance of Nitrous Oxide for Patients Undergoing Major Surgery: A Randomized Controlled Trial

Myles PS, Leslie K, Chan MTV, Forbes A, Paech MJ, Peyton P, Silbert BS, Pascoe E; the ENIGMA Trial Group

A randomized, controlled trial included 2,050 patients undergoing major surgery who were administered either nitrous oxide-free or nitrous oxide-based anesthesia. The study concluded that avoidance of nitrous oxide and the accompanying increase in inspired oxygen concentration decreased the incidence of major complications.

Nitrous oxide and risk of surgical wound infection: a randomised trial

Fleischmann E, Lenhardt R, Kurz A, Herbst F, Fülesdi B, Greif R, Sessler DI, Akça O; On behalf of the Outcomes Research Group

A randomised trial of 418 patients undergoing colon resection were administered either 65% intraoperative nitrous oxide or nitrogen and concluded that nitrous oxide does not increase the incidence of wound infection.