Fraction of inspired oxygen during general anesthesia for non-cardiac surgery: Systematic review and meta-analysis

Maria Høybye; Peter C. Lind; Mathias J. Holmberg; Maria Bolther; Marie K. Jessen; Mikael Fink Vallentin; Frederik B. Hansen; Johanne M. Holst; Andreas Magnussen; Niklas S. Hansen; Cecilie M. Johannsen; Johannes Enevoldsen; Thomas H. Jensen; Lara L. Roessler; Maibritt P. Klitholm; Mark A. Eggertsen; Philip Caap; Caroline Boye; Karol M. Dabrowski; Lasse Vormfenne; Jeppe Henriksen; Mathias Karlsson; Ida R. Balleby; Marie S. Rasmussen; Kim Pælestik; Asger Granfeldt; Lars W. Andersen

doi:10.1111/aas.14102

Fraction of inspired oxygen during general anesthesia for non-cardiac surgery: Systematic review and meta-analysis

Maria Høybye, Peter C. Lind, Mathias J. Holmberg, Maria Bolther, Marie K. Jessen, Mikael Fink Vallentin, Frederik B. Hansen, Johanne M. Holst, Andreas Magnussen, Niklas S. Hansen, Cecilie M. Johannsen, Johannes Enevoldsen, Thomas H. Jensen, Lara L. Roessler, Maibritt P. Klitholm, Mark A. Eggertsen, Philip Caap, Caroline Boye, Karol M. Dabrowski, Lasse VormfenneJeppe Henriksen, Mathias Karlsson, Ida R. Balleby, Marie S. Rasmussen, Kim Pælestik, Asger Granfeldt, Lars W. Andersen^*

^*Corresponding author af dette arbejde

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

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Abstract

Background: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO₂) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO₂ on postoperative outcomes. Methods: PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO₂ 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%) FiO₂. Risk of bias was intermediate for all trials. A high FiO₂ did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81–1.02 [p =.10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90–1.79 [p =.18]) and hospital length of stay (mean difference = 0.03 days, 95% CI −0.25 to 0.30 [p =.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 FiO₂ did not improve outcomes including surgical site infections, length of stay, or mortality. However, the certainty of the evidence was assessed as low.

Originalsprog	Engelsk
Tidsskrift	Acta Anaesthesiologica Scandinavica
Vol/bind	66
Nummer	8
Sider (fra-til)	923-933
Antal sider	11
ISSN	0001-5172
DOI	https://doi.org/10.1111/aas.14102
Status	Udgivet - sep. 2022

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10.1111/aas.14102Licens: CC BY

Acta Anaesthesiol Scand - 2022 - H ybye - Fraction of inspired oxygen during general anesthesia for non‐cardiac surgery Forlagets udgivne version, 982 KBLicens: CC BY

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Høybye, M., Lind, P. C., Holmberg, M. J., Bolther, M., Jessen, M. K., Fink Vallentin, M., Hansen, F. B., Holst, J. M., Magnussen, A., Hansen, N. S., Johannsen, C. M., Enevoldsen, J., Jensen, T. H., Roessler, L. L., Klitholm, M. P., Eggertsen, M. A., Caap, P., Boye, C., Dabrowski, K. M., ... Andersen, L. W. (2022). Fraction of inspired oxygen during general anesthesia for non-cardiac surgery: Systematic review and meta-analysis. Acta Anaesthesiologica Scandinavica, 66(8), 923-933. https://doi.org/10.1111/aas.14102

@article{d242d23f6d4e44e49609b2e9c1fc5c32,

title = "Fraction of inspired oxygen during general anesthesia for non-cardiac surgery: Systematic review and meta-analysis",

abstract = "Background: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO2) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO2 on postoperative outcomes. Methods: PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO2 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%) FiO2. Risk of bias was intermediate for all trials. A high FiO2 did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81–1.02 [p =.10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90–1.79 [p =.18]) and hospital length of stay (mean difference = 0.03 days, 95% CI −0.25 to 0.30 [p =.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 FiO2 did not improve outcomes including surgical site infections, length of stay, or mortality. However, the certainty of the evidence was assessed as low.",

keywords = "complications, fraction of inspired oxygen, general anesthesia, meta-analysis, outcomes, systematic review",

author = "Maria H{\o}ybye and Lind, {Peter C.} and Holmberg, {Mathias J.} and Maria Bolther and Jessen, {Marie K.} and {Fink Vallentin}, Mikael and Hansen, {Frederik B.} and Holst, {Johanne M.} and Andreas Magnussen and Hansen, {Niklas S.} and Johannsen, {Cecilie M.} and Johannes Enevoldsen and Jensen, {Thomas H.} and Roessler, {Lara L.} and Klitholm, {Maibritt P.} and Eggertsen, {Mark A.} and Philip Caap and Caroline Boye and Dabrowski, {Karol M.} and Lasse Vormfenne and Jeppe Henriksen and Mathias Karlsson and Balleby, {Ida R.} and Rasmussen, {Marie S.} and Kim P{\ae}lestik and Asger Granfeldt and Andersen, {Lars W.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.",

year = "2022",

month = sep,

doi = "10.1111/aas.14102",

language = "English",

volume = "66",

pages = "923--933",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

publisher = "Wiley-Blackwell Publishing, Inc.",

number = "8",

}

Høybye, M , Lind, PC , Holmberg, MJ , Bolther, M , Jessen, MK , Fink Vallentin, M , Hansen, FB, Holst, JM, Magnussen, A, Hansen, NS, Johannsen, CM, Enevoldsen, J, Jensen, TH, Roessler, LL, Klitholm, MP, Eggertsen, MA, Caap, P, Boye, C, Dabrowski, KM, Vormfenne, L, Henriksen, J, Karlsson, M, Balleby, IR, Rasmussen, MS, Pælestik, K, Granfeldt, A & Andersen, LW 2022, 'Fraction of inspired oxygen during general anesthesia for non-cardiac surgery: Systematic review and meta-analysis', Acta Anaesthesiologica Scandinavica, bind 66, nr. 8, s. 923-933. https://doi.org/10.1111/aas.14102

Fraction of inspired oxygen during general anesthesia for non-cardiac surgery: Systematic review and meta-analysis. / Høybye, Maria ; Lind, Peter C.; Holmberg, Mathias J. et al.
I: Acta Anaesthesiologica Scandinavica, Bind 66, Nr. 8, 09.2022, s. 923-933.

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

TY - JOUR

T1 - Fraction of inspired oxygen during general anesthesia for non-cardiac surgery

T2 - Systematic review and meta-analysis

AU - Høybye, Maria

AU - Lind, Peter C.

AU - Holmberg, Mathias J.

AU - Bolther, Maria

AU - Jessen, Marie K.

AU - Fink Vallentin, Mikael

AU - Hansen, Frederik B.

AU - Holst, Johanne M.

AU - Magnussen, Andreas

AU - Hansen, Niklas S.

AU - Johannsen, Cecilie M.

AU - Enevoldsen, Johannes

AU - Jensen, Thomas H.

AU - Roessler, Lara L.

AU - Klitholm, Maibritt P.

AU - Eggertsen, Mark A.

AU - Caap, Philip

AU - Boye, Caroline

AU - Dabrowski, Karol M.

AU - Vormfenne, Lasse

AU - Henriksen, Jeppe

AU - Karlsson, Mathias

AU - Balleby, Ida R.

AU - Rasmussen, Marie S.

AU - Pælestik, Kim

AU - Granfeldt, Asger

AU - Andersen, Lars W.

PY - 2022/9

Y1 - 2022/9

N2 - Background: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO2) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO2 on postoperative outcomes. Methods: PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO2 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%) FiO2. Risk of bias was intermediate for all trials. A high FiO2 did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81–1.02 [p =.10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90–1.79 [p =.18]) and hospital length of stay (mean difference = 0.03 days, 95% CI −0.25 to 0.30 [p =.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 FiO2 did not improve outcomes including surgical site infections, length of stay, or mortality. However, the certainty of the evidence was assessed as low.

AB - Background: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO2) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO2 on postoperative outcomes. Methods: PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO2 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%) FiO2. Risk of bias was intermediate for all trials. A high FiO2 did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81–1.02 [p =.10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90–1.79 [p =.18]) and hospital length of stay (mean difference = 0.03 days, 95% CI −0.25 to 0.30 [p =.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 FiO2 did not improve outcomes including surgical site infections, length of stay, or mortality. However, the certainty of the evidence was assessed as low.

KW - complications

KW - fraction of inspired oxygen

KW - general anesthesia

KW - meta-analysis

KW - outcomes

KW - systematic review

UR - http://www.scopus.com/inward/record.url?scp=85132370618&partnerID=8YFLogxK

U2 - 10.1111/aas.14102

DO - 10.1111/aas.14102

M3 - Review

C2 - 35675085

AN - SCOPUS:85132370618

SN - 0001-5172

VL - 66

SP - 923

EP - 933

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 8

ER -

Fraction of inspired oxygen during general anesthesia for non-cardiac surgery: Systematic review and meta-analysis

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