P016: HIGH FRACTIONAL INSPIRED OXYGEN, FRIEND OR FOE?
Ralph Michel, Albert Robinson, MD, Christopher Giordano, MD; University of Florida
Intro: Surgical site infections (SSI) have been reported as being tied for the most common type of healthcare acquired infections (HAI) with pneumonia (1). With surgical procedures on the rise, many efforts are being made to identify both potential culprits for this statistic along with possible solutions. An estimated 8,205 annual surgical site infections leading to mortality has initiated efforts to reduce this healthcare problem (2). Another strong incentive being cost associated with these infections. Surgical site infections are responsible for approximately $3.2 billion dollars in associated costs (3). The potential shift towards the bundled payment model makes the cost associated with these infections more worrisome to hospitals and providers alike. Bundled payments or episode based-payment is the provision of a set dollar amount for a specific episode of care regardless of complications. The expenses associated with SSIs is considered an additional expense in this regard, and could exceed the amount that was initially provided to the hospital.
Methods: A literature search was performed on PubMed using the following MESH term: "Intraoperative Period"[Mesh] AND inspired oxygen OR oxygen fraction AND infect* AND (Humans[Mesh]).” This initial search resulted in a total of 332 articles which were initially screened using their titles and abstracts. The initial screen resulted in a total of 21 articles which were further filtered down to 9 articles with an in-depth paper analysis. Inclusion criteria were studies from all surgical specialties implementing high FiO2 rates intraoperatively, most of the studies also continued this for a variable amount of time postoperatively, then observing the patient for signs of infection (which were individually defined by each study). Exclusion criteria were studies on animal models and other meta-analyses. However, the meta-analysis was used for a cited reference search, which allowed for a more inclusive data search.
Results: A preliminary data analysis included 10 articles ranging from 2004 to 2016. These articles included at a total of 3,428 subjects in the following surgical fields: colorectal, breast/soft tissue, gynecology, neurosurgery, obstetrics, and orthopedics, with an average of 1.7 surgical specialties per article. The most frequently appearing surgical specialty was colorectal; appearing in 70% of the studies. A total of 50% of the studies provided results that supported the use of increased FiO2 intraoperatively. The remaining 50% did not find compelling evidence to support the use of increased FiO2.
Conclusion: Even though the WHO recently recommended the use of high FiO2 as a means to reduce SSIs, there is no strong evidence supporting the benefit of this practice. There is also no evidence detailing accounts of adverse effects as a result of high FiO2. That being said, this should be left to the physician’s discretion on a case by case basis until additional data provides more clarity on this controversial topic.