APHP Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Tenon, 75020 Paris, France; Centre Hospitalier Régional Universitaire de Brest, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 29200 Brest, France.
Centre Hospitalier Régional Universitaire de Brest, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 29200 Brest, France; Faculté de médecine et de sciences de la santé de Brest, 29238 Brest, France.
Anaesth Crit Care Pain Med. 2020 Dec;39(6):847-858. doi: 10.1016/j.accpm.2020.07.019. Epub 2020 Oct 7.
Despite numerous studies, controversies about the best intraoperative FiO remain. In 2016, the World Health Organization (WHO) recommended that adult patients undergoing general anaesthesia should be ventilated intraoperatively with an 80% FiO to reduce surgical site infection (SSI). However, several data suggest that hyperoxia could have adverse effects. In order to determine the potential effect of FiO on SSI, we included in this systematic review 23 studies (among which 21 randomised controlled trials [RCT]) published between 1999 and 2020, comparing intraoperative high versus low FiO. Results were heterogeneous but most recent studies on one hand, and the largest RCTs on the other hand, reported no difference on the incidence of SSI regarding intraoperative FiO during general anaesthesia. There was also no difference in the incidence of SSI depending of intraoperative FiO in patients receiving regional anaesthesia. The review on secondary endpoints (respiratory and cardiovascular adverse events, postoperative nausea and vomiting, postoperative length-of-stay and mortality) also failed to support the use of high FiO. On the opposite, some data from follow-up analyses and registry studies suggested a possible negative effect of high intraoperative FiO on long-term outcomes. In conclusion, the systematic administration of a high intraoperative FiO in order to decrease SSI or improve other perioperative outcomes seems unjustified in the light of the evidence currently available in the literature.
尽管有大量研究，但关于最佳术中 FiO2 值仍存在争议。2016 年，世界卫生组织（WHO）建议全身麻醉的成年患者术中应使用 80%的 FiO2 进行通气，以降低手术部位感染（SSI）的风险。然而，有几项数据表明，高氧可能会产生不良影响。为了确定 FiO2 对 SSI 的潜在影响，我们纳入了这项系统评价中的 23 项研究（其中 21 项为随机对照试验[RCT]），这些研究发表于 1999 年至 2020 年期间，比较了术中高 FiO2 与低 FiO2 的效果。结果存在异质性，但最近的大多数研究，以及最大的 RCT 研究，都报告了术中 FiO2 对全麻期间 SSI 发生率没有影响。在接受区域麻醉的患者中，术中 FiO2 对 SSI 发生率也没有影响。对次要终点（呼吸和心血管不良事件、术后恶心呕吐、术后住院时间和死亡率）的评价也未能支持使用高 FiO2。相反，一些随访分析和登记研究的数据表明，高术中 FiO2 可能对长期结局产生负面影响。总之，鉴于目前文献中的证据，系统地给予高术中 FiO2 以降低 SSI 或改善其他围手术期结局似乎是不合理的。
