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Τετάρτη 28 Ιουνίου 2017

Supplemental oxygen and surgical site infection: getting to the truth

Surgical site infection (SSI) remains one of the most serious and expensive postoperative complications.1 Infected patients are twice as likely to need admission to critical care and twice as likely to die.2 The primary defence against SSI is oxidative killing by neutrophils, and molecular oxygen is the substrate.3 Resistance to infection is thus a strong function of tissue oxygen partial pressure over the clinical range. One might thus expect that supplemental perioperative oxygen (∼80%) would reduce infection risk when compared with more traditional inspired oxygen concentrations (∼30%) during anaesthesia and surgery. Despite some early evidence supporting the role of supplemental oxygen in reducing the risk of SSI,4 there have since been conflicting results from numerous randomized clinical trials. The most compelling data come from the PROXI trial,5 a large, multicentre, randomized trial enrolling 1400 patients undergoing abdominal surgery. This trial found no evidence of any beneficial effect of supplemental oxygen; SSI occurred in 131 of 685 patients (19%) receiving 80% oxygen and in 141 of 701 (20%) receiving 30% oxygen [odds ratio 0.94 (95% confidence interval 0.72–1.22), P=0.64]. Indeed, a long-term follow-up study (median 2.3 years after surgery) found poorer survival in the supplemental oxygen group.6

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