High Inspired Oxygen Fraction and Surgical Site Infection

Evidence continues to accumulate on whether the use of high inspired oxygen fraction (FIO₂) is effective for preventing surgical site infections (SSIs). In 2000, a randomized trial by Greif et al¹ demonstrated that SSIs were significantly decreased following colon surgery in patients who received 80% oxygen intraoperatively and for the first 2 hours following surgery. Subsequent clinical trials by Belda et al² and by Myles et al³ supported the use of perioperative supplemental high inspired oxygen for reducing risk of surgical wound infection, whereas a clinical trial by Pryor et al⁴ suggested that perioperative hyperoxia was not effective in reducing SSIs (and in fact increased them). A trial by Mayzler et al⁵ reported only 5 of 38 patients as developing SSI overall and thus had inadequate power to draw conclusions. A meta-analysis⁶ of these trials, pooling the outcomes of 3001 patients, found that perioperative administration of high inspired oxygen (80% concentration) was associated with a 3% absolute reduction (crude infection rates of 12% in the control group and 9% in the group receiving 80% oxygen) and a 25% relative reduction in risk of SSI.