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Maria Høybye

Fraction of Inspired Oxygen During General Anesthesia for Non-Cardiac Surgery: Systematic Review and Meta-Analysis

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Review › Forskning › peer review

DOI

  • Maria Høybye
  • Peter Carøe Lind
  • Mathias J Holmberg
  • Maria Bolther, aDepartment of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark bViro-Immunology Research Unit cDepartment of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen dDepartment of Clinical Immunology, Aarhus University Hospital, Aarhus eDepartment of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen fDepartment of Infectious Diseases, Odense University Hospital, Odense gDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
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  • Marie K Jessen
  • Mathias J Holmberg
  • Frederik B Hansen
  • Johanne M Holst
  • Andreas Magnussen
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  • Niklas S Hansen, From the *Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore; †Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark; and ‡Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark., aDepartment of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark bViro-Immunology Research Unit cDepartment of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen dDepartment of Clinical Immunology, Aarhus University Hospital, Aarhus eDepartment of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen fDepartment of Infectious Diseases, Odense University Hospital, Odense gDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
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  • Cecilie M Johannsen
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  • Johannes Enevoldsen
  • Thomas H Jensen
  • Lara L Roessler, Clinical Cell Biology, Research Unit of Pathology, Department of Clinical Research, University of Southern Denmark and Department of Pathology, Odense University Hospital, Odense, Denmark; Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Clinical Cell Biology, Vejle Hospital - Lillebælt Hospital, University of Southern Denmark, Vejle, Denmark; Department of Forensic Medicine, Aarhus University, Aarhus, Denmark. Electronic address: thomas.levin.andersen@rsyd.dk.
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  • Maibritt P Klitholm, aDepartment of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark bViro-Immunology Research Unit cDepartment of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen dDepartment of Clinical Immunology, Aarhus University Hospital, Aarhus eDepartment of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen fDepartment of Infectious Diseases, Odense University Hospital, Odense gDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
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  • Mark A Eggertsen
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  • Philip Caap
  • Caroline Boye
    • ,
  • Karol M Dabrowski
  • Lasse Vormfenne, Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Centre for Integrative Sequencing (iSEQ), Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Psychiatric Department, Aarhus University Hospital, Aarhus, Denmark.
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  • Jeppe Henriksen, aDepartment of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark bViro-Immunology Research Unit cDepartment of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen dDepartment of Clinical Immunology, Aarhus University Hospital, Aarhus eDepartment of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen fDepartment of Infectious Diseases, Odense University Hospital, Odense gDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
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  • C M Karlsson, From the *Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore; †Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark; and ‡Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark., Department of Nephrology, Aalborg Hospital, Aarhus University Hospital, Moelleparkvej 4, 9000 Aalborg, Denmark ; Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
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  • Ida R Balleby, Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands.
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  • Marie S Rasmussen, From the *Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore; †Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark; and ‡Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark., Department of Nephrology, Aalborg Hospital, Aarhus University Hospital, Moelleparkvej 4, 9000 Aalborg, Denmark ; Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
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  • Kim Paelestik, From the *Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore; †Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark; and ‡Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark.
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  • Asger Granfeldt
  • Lars W Andersen

BACKGROUND: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO 2 ) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO 2 on postoperative outcomes.

METHODS: PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO 2 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%) FiO 2 . Risk of bias was intermediate for all trials. A high FiO 2 did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81 to 1.02 [p = 0.10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90 to 1.79 [p = 0.18]) and hospital length of stay (mean difference = 0.03 days, 95% CI -0.25 to 0.30 [p = 0.84).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 FiO 2 did not improve outcomes including surgical site infections, length of stay, or mortality. However, the certainty of the evidence was assessed as low.

OriginalsprogEngelsk
TidsskriftActa Anaesthesiologica Scandinavica
ISSN0001-5172
DOI
StatusE-pub ahead of print - 8 jun. 2022

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