HIGHER CONCENTRATION OF INTRAOPERATIVE FIO₂

Might lower surgical site infection rates without incurring great risk.

In a recent editorial, a physician advocates the administration of a higher oxygen concentration in surgical patients to help reduce surgical site infection rates, in an argument based on current and previous research conducted on the topic, although all such studies did not reach the same conclusion regarding the possible benefit conferred in the practice.

The author examined the findings of three research trials, the most recent one a study published in 2005 involving patients undergoing colorectal surgery in which the researchers found that in those who received intraoperative 80% fraction of inspired oxygen (FIO₂) (n = 148) rather than 30% FIO₂ (n = 143) there was a 39% lesser risk of the development of surgical site infection. In a study published in 2000, a randomized trial of 500 patients also undergoing colorectal surgery, there were comparable results-a surgical site infection rate of 5.2% in the group given 80% FIO₂ (n = 250), and a rate of 11.2% in the group given 30% FIO₂ (n = 250). However, a study published in 2004 yielded markedly different results-in a randomized, controlled trial in which FIO₂ concentrations of 80% in one group and 35% in another were used, the surgical site infection rate was 25% and 11%, respectively. One of the differences in that study that might partially account for the discrepant findings is the performance of a variety of abdominal procedures, not only colorectal surgery.

The author asserts that, because the administration of a high concentration of FIO₂ during surgery poses little risk and has been proven effective in two independent trials, the practice is supportable despite the lack of unanimous agreement concerning it and recommends that the surgical team strive to reduce surgical infection rates also by using established preventive methods, such as the administration of the right antibiotic at the right time, the maintenance of normal glucose levels, and the clipping (rather than shaving) of hair in surgical preparation.

Belda FJ, et al. JAMA 2005;294(16):2035-42; Greif R, et al. N Engl J Med 2000;342(3):161-7; Pryor KO, et al. JAMA 2004;291(1):79-87.