Perioperative Oxygenation Targets in Adults

Purpose of Review: Oxygen therapy is administered liberally to give a margin of safety against life-threatening hypoxia; however, excessive supplementary oxygen may increase the risk of serious adverse events with a potential negative impact on both morbidity and mortality. This review focuses on the current evidence and emerging data relating to oxygen therapy in the perioperative setting. Recent Findings: Current controversies around evidence-based guidelines for perioperative oxygen therapy present a serious challenge for anesthetists. Recommendations vary from very high fractions of inspired oxygen for prevention of wound infections to targeting normoxemia for prevention of organ dysfunction. The relevance of emerging evidence of increased mortality with liberal oxygen therapy in acutely ill adults to the predominantly elective surgical population is unclear. However, recent data indicate that evidence to support liberal oxygen to prevent wound infections is frail, and so the potential that liberal oxygen therapy might cause harm is of particular concern. Summary: While optimal oxygenation targets are a matter of debate, defining upper limits of acceptable arterial oxygenation perioperatively in surgical patients to reduce tissue injury induced by hyperoxemia is a reasonable approach.