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 F. 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 F. 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

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Abstract

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 0.81-1.02 [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 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.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	66
Issue number	8
Pages (from-to)	923-933
Number of pages	11
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.14102
Publication status	Published - Sept 2022

Bibliographical note

Keywords

complications
fraction of inspired oxygen
general anesthesia
meta-analysis
outcomes
systematic review
Anesthesia, General
Oxygen
Humans
Adult
Surgical Wound Infection

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Høybye, M., Lind, P. C., Holmberg, M. J., Bolther, M., Jessen, M. K., Vallentin, M. F., 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. Advance online publication. https://doi.org/10.1111/aas.14102

@article{d026c36e0d65435ba886ba4a74379013,

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 (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 0.81-1.02 [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 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. ",

keywords = "complications, fraction of inspired oxygen, general anesthesia, meta-analysis, outcomes, systematic review, Anesthesia, General, Oxygen, Humans, Adult, Surgical Wound Infection",

author = "Maria H{\o}ybye and Lind, {Peter C.} and Holmberg, {Mathias J.} and Maria Bolther and Jessen, {Marie K.} and Vallentin, {Mikael F.} 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 = "{\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",

number = "8",

}

Høybye, M, Lind, PC, Holmberg, MJ, Bolther, M, Jessen, MK, Vallentin, MF, 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, vol. 66, no. 8, pp. 923-933. https://doi.org/10.1111/aas.14102

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 - Vallentin, Mikael F.

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 (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 0.81-1.02 [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 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.

AB - 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 0.81-1.02 [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 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.

KW - complications

KW - fraction of inspired oxygen

KW - general anesthesia

KW - meta-analysis

KW - outcomes

KW - systematic review

KW - Anesthesia, General

KW - Oxygen

KW - Humans

KW - Adult

KW - Surgical Wound Infection

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

U2 - 10.1111/aas.14102

DO - 10.1111/aas.14102

M3 - Review article

C2 - 35675085

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

Abstract

Bibliographical note

Keywords

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