Effects of high vs. low perioperative inspired oxygen fraction on length of hospital stay and postoperative complications: a systematic review, meta-analysis, and trial sequential analysis.
Summary
Across 31 RCTs (10,506 patients), high versus low FiO2 did not change length of stay, postoperative organ complications, SSI, or mortality; trial sequential analysis indicated sufficient information size for the primary outcome. Sensitivity analysis suggested high FiO2 may increase postoperative atelectasis.
Key Findings
- No difference in length of hospital stay between high and low FiO2 (MD -0.01 days; 95% CI -0.10 to 0.08).
- No significant differences in postoperative cardiac, cerebral, renal, or pulmonary complications, SSI, or mortality.
- Trial sequential analysis indicated the primary outcome evidence is conclusive; sensitivity analysis suggested high FiO2 may increase postoperative atelectasis.
Clinical Implications
Routine use of high FiO2 to prevent SSI should be reconsidered; individualized oxygen titration to normoxia and vigilance for atelectasis may be safer.
Why It Matters
Challenges guideline-endorsed high FiO2 use by showing no clinical benefit and a signal for harm (atelectasis) across diverse surgeries, with robust meta-analytic and TSA methodology.
Limitations
- Heterogeneity in FiO2 protocols and timing across trials may dilute subgroup effects.
- Signal for atelectasis depended on sensitivity analysis excluding a single study.
Future Directions
Patient-level meta-analyses and RCTs comparing titrated normoxia vs. liberal oxygen with standardized lung-protective strategies to clarify atelectasis risk and benefit-risk tradeoffs.
Study Information
- Study Type
- Systematic Review/Meta-analysis
- Research Domain
- Prevention/Treatment
- Evidence Level
- I - Meta-analysis of randomized controlled trials with trial sequential analysis.
- Study Design
- OTHER