Effects of oxygen on post-surgical infections during an individualised perioperative open-lung ventilatory strategy: a randomised controlled trial
Por:
Ferrando, C, Aldecoa, C, Unzueta, C, Belda, FJ, Librero, J, Tusman, G, Suarez-Sipmann, F, Peiro, S, Pozo, N, Brunelli, A, Garutti, I, Gallego, C, Rodriguez, A, Garcia, JI, Diaz-Cambronero, O, Balust, J, Redondo, FJ, de la Matta, M, Gallego-Ligorit, L, Hernandez, J, Martinez, P, Perez, A, Leal, S, Alday, E, Monedero, P, Gonzalez, R, Mazzirani, G, Aguilar, G, Lopez-Baamonde, M, Felipe, M, Mugarra, A, Torrente, J, Valencia, L, Varon, V, Sanchez, S, Rodriguez, B, Martin, A, India, I, Azparren, G, Molina, R, Villar, J, Soro, M, Acosta, J, Alberola, MJ, Alcon, A, Almajano, R, Alvarez, C, Anaya, R, Aragon, C, Argilaga, M, Arocas, B, Ayas, B, Balandron, V, Barcena, E, Bejarano, N, Belmonte, L, Berges, V, Bermejo, MG, Cabadas, R, Cabrera, S, Callejas, R, Carbonell, J, Carrizo, J, Castillo, J, Charco, P, Colas, A, Colomina, L, Cotter, L, Cruz, P, Cuervo, J, Del Castillo, G, Del Rio, E, Delgado, J, Dexeus, C, Diaz, R, Dinu, M, Duca, A, Duque, P, Echarri, G, Fabra, P, Fernandez, C, Florea, R, Forcada, P, Fuentes, I, Garces, C, Del Valle, SG, Garcia, B, Garcia, E, Garcia, M, Garrigues, B, Gil, F, Gonzalez, D, Gracia, A, Gracia, E, Cranell, M, Guerra, Y, Gutierrez, A, Hernando, J, Herrero, M, Ibanez, M, Imaz, I, Izquierdo, B, Jurado, A, Lafuente, N, Lascorz, L, Leon, I, Lopez, A, Lopez-Herrera, D, Lozano, A, Marcos, JM, Martinez, G, Martinez, S, Mata, E, Matoses, S, Mendez, R, Merino, M, Millaruelo, A, Molina, CR, Monleon, B, Montenegro, OM, Munoz, JL, Oliver-Fornies, P, Ortega, M, Palencia, MA, Parera, A, Pastor, E, Perez, MD, Perez, S, Pestana, D, Pinol, S, Puig, J, Pujol, R, Quesada, N, Ramon, A, Rego, C, Reviriego, L, Rodriguez, R, Romero, B, Romero, E, Rosello, M, Rovira, L, Ruiz, L, Sancho, L, Sandin, F, Serralta, F, Tres, E, Valls, P, Vaquero, L, Varela, M, Vega, V, Viguera, L, Villazala, R, Villena, A, Visiedo, S
Publicada:
1 ene 2020
Resumen:
Background: We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery.
Methods: We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality.
Results: We enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59-1.50; P=0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48-1.25; P=0.38) and myocardial ischaemia (0.6% [n=2] vs 0% [n=0]; P=0.47) did not differ between groups.
Conclusions: An oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found.
Filiaciones:
Ferrando, C:
Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain
Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain
Aldecoa, C:
Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain
Unzueta, C:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Belda, FJ:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Librero, J:
UPNA, REDISSEC Red Invest Serv Salud Enfermedades Cron, Complejo Hosp Navarra, Navarrabiomed, Valencia, Spain
Tusman, G:
Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, Mar Del Plata, Buenos Aires, Argentina
Suarez-Sipmann, F:
Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain
Uppsala Univ Hosp, Dept Surg Sci, Hedenstierna Lab, Uppsala, Sweden
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Peiro, S:
Fdn Fomento Invest Sanitaria & Biomed Comunidad V, Red Invest Serv Salud Enfermedades Cron REDISSEC, Valencia, Spain
Pozo, N:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Brunelli, A:
Hosp Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain
Garutti, I:
Hosp Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain
Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain
Gallego, C:
Hosp Univ Ramon & Cajal, Dept Anesthesiol & Crit Care, Madrid, Spain
Rodriguez, A:
Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain
Garcia, JI:
Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain
Diaz-Cambronero, O:
Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain
Balust, J:
Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain
Redondo, FJ:
Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain
de la Matta, M:
Hosp Univ Virgen del Rocio, Dept Anesthesiol & Crit Care, Seville, Spain
Gallego-Ligorit, L:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Hernandez, J:
Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain
Martinez, P:
Hosp Albacete, Dept Anesthesiol & Crit Care, Albacete, Spain
Perez, A:
Hosp Elche, Dept Anesthesiol & Crit Care, Elche, Spain
Leal, S:
Hosp Povisa, Dept Anesthesiol & Crit Care, Vigo, Spain
Alday, E:
Hosp Univ La Princesa, Dept Anesthesiol & Crit Care, Madrid, Spain
Monedero, P:
Clin Univ Navarra, Dept Anesthesiol & Crit Care, Pamplona, Spain
Gonzalez, R:
Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain
Mazzirani, G:
Hosp Manises, Dept Anesthesiol, Manises, Spain
Aguilar, G:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Lopez-Baamonde, M:
Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain
Felipe, M:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Mugarra, A:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Torrente, J:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Valencia, L:
Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain
Varon, V:
Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain
Sanchez, S:
Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain
Rodriguez, B:
Hosp Povisa, Dept Anesthesiol & Crit Care, Vigo, Spain
Martin, A:
Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain
India, I:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Azparren, G:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Molina, R:
Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain
Villar, J:
Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain
Hosp Univ Dr Negrin, Res Unit, Multidisciplinary Organ Dysfunct Evaluat Res Netw, Las Palmas Gran Canaria, Spain
St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr Biomed Sci, Toronto, ON, Canada
Soro, M:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Acosta, J:
Hosp Univ Virgen del Rocio, Dept Anesthesiol & Crit Care, Seville, Spain
Alberola, MJ:
Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain
Alcon, A:
Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain
Almajano, R:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Alvarez, C:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Anaya, R:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Aragon, C:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Argilaga, M:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Arocas, B:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Ayas, B:
Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain
Balandron, V:
Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain
Barcena, E:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Bejarano, N:
Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain
Belmonte, L:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Berges, V:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Bermejo, MG:
Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain
Cabadas, R:
Hosp Povisa, Dept Anesthesiol & Crit Care, Vigo, Spain
Cabrera, S:
Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain
Callejas, R:
Clin Univ Navarra, Dept Anesthesiol & Crit Care, Pamplona, Spain
Carbonell, J:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Carrizo, J:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Castillo, J:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Charco, P:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Colas, A:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Colomina, L:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Cotter, L:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Cruz, P:
Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain
Cuervo, J:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Del Castillo, G:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Del Rio, E:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Delgado, J:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Dexeus, C:
Hosp Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain
Diaz, R:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Dinu, M:
Hosp Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain
Duca, A:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Duque, P:
Clin Univ Navarra, Dept Anesthesiol & Crit Care, Pamplona, Spain
Echarri, G:
Clin Univ Navarra, Dept Anesthesiol & Crit Care, Pamplona, Spain
Fabra, P:
Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain
Fernandez, C:
Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain
Florea, R:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Forcada, P:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Fuentes, I:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Garces, C:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Del Valle, SG:
Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain
Garcia, B:
Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain
Garcia, E:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Garcia, M:
Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Garrigues, B:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Gil, F:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Gonzalez, D:
Hosp Univ Virgen del Rocio, Dept Anesthesiol & Crit Care, Seville, Spain
Gracia, A:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Gracia, E:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Cranell, M:
Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain
Guerra, Y:
Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain
Gutierrez, A:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Hernando, J:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Herrero, M:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Ibanez, M:
Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain
Imaz, I:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Izquierdo, B:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Jurado, A:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Lafuente, N:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Lascorz, L:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Leon, I:
Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain
Lopez, A:
Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain
Lopez-Herrera, D:
Hosp Univ Virgen del Rocio, Dept Anesthesiol & Crit Care, Seville, Spain
Lozano, A:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Marcos, JM:
Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain
Martinez, G:
Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain
Martinez, S:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Mata, E:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Matoses, S:
Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain
Mendez, R:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Merino, M:
Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain
Millaruelo, A:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Molina, CR:
Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain
Monleon, B:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Montenegro, OM:
Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain
Munoz, JL:
Hosp Elche, Dept Anesthesiol & Crit Care, Elche, Spain
Oliver-Fornies, P:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Ortega, M:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Palencia, MA:
Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain
Parera, A:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Pastor, E:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Perez, MD:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Perez, S:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Pestana, D:
Hosp Univ Ramon & Cajal, Dept Anesthesiol & Crit Care, Madrid, Spain
Pinol, S:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain
Puig, J:
Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain
Pujol, R:
Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain
Quesada, N:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Ramon, A:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Rego, C:
Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain
Reviriego, L:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Rodriguez, R:
Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain
Romero, B:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Romero, E:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Rosello, M:
Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain
Rovira, L:
Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain
Ruiz, L:
Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain
Sancho, L:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Sandin, F:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Serralta, F:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Tres, E:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Valls, P:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Vaquero, L:
Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain
Varela, M:
Hosp Povisa, Dept Anesthesiol & Crit Care, Vigo, Spain
Vega, V:
Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain
Viguera, L:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Villazala, R:
Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain
Villena, A:
Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain
Visiedo, S:
Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain
Fdn Miguel Servet, Navarrabiomed, Red Invest Serv Salud Enfermedades Cron REDISSEC, Pamplona, Spain.
Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, Mar De Plata, Argentina.
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