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Editorial |

High Inspired Oxygen Fraction and Surgical Site Infection

Thomas K. Hunt, MD; Harriet W. Hopf, MD
JAMA. 2009;302(14):1588-1589. doi:10.1001/jama.2009.1478.
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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.

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