Effect of intraoperative hyperoxia on the incidence of surgical site infections: a meta-analysis.

BACKGROUND: Whether supplemental intraoperative oxygen reduces surgical site infections remains unclear. Recent recommendations from the World Health Organization and Center for Disease Control to routinely use high inspired oxygen concentrations to reduce infection risk have been widely criticized. We therefore performed a meta-analysis to evaluate the influence of inspired oxygen on infection risk, including a recent large trial. METHODS: A systematic literature search was performed. Primary analysis included all eligible trials. Sensitivity analyses distinguished studies of colorectal and non-colorectal surgeries, and excluded studies with high risk of bias. Another post-hoc sensitivity analysis excluded studies from one author that appear questionable. RESULTS: The primary analysis included 26 trials (N=14,710). The RR [95%CI] for wound infection was 0.81 [0.70, 0.94] in the high vs. low inspired oxygen groups. The effect remained significant in colorectal patients (N=10,469), 0.79 [0.66, 0.96], but not in other patients (N=4,241), 0.86 [0.69, 1.09]. When restricting the analysis to studies with low risk of bias, either by strict inclusion criteria (N=5,047) or by researchers' judgment (N=12,547), no significant benefit remained: 0.84 [0.67, 1.06] and 0.89 [0.76, 1.05], respectively. CONCLUSIONS: When considering all available data, intraoperative hyperoxia reduced wound infection incidence. However, no significant benefit remained when analysis was restricted to objective- or investigator-identified low-bias studies, although those analyses were not as well-powered. Meta-analysis of the most reliable studies does not suggest that supplemental oxygen substantively reduces wound infection risk, but more research is needed to fully answer this question.

Attenuation artifacts in SPECT: effect of wrap-around lung in 180 degrees cardiac studies.

UNLABELLED: We estimated that in 75%-90% of PET 82Rb patients the left lung appeared to wrap around the anterior aspect of the left ventricle. We used clinical PET 82Rb myocardial perfusion studies as the input to a SPECT computer simulation model to determine if patients with left lung wrap-around displayed consistent artifacts in reconstructed SPECT images. In particular, we sought an explanation for the hot lateral wall seen in SPECT images from normal female and male patients. METHODS: Attenuated SPECT 201Tl emission data were simulated from a mid-ventricular slice in 10 randomly selected clinical PET 82Rb studies with left lung wrap-around. In these same cases, the influence of left lung wrap-around was removed by assigning the left lung an attenuation coefficient which matched that of the heart. Five randomly selected clinical PET 82Rb studies without left lung wrap-around were also processed with our model. RESULTS: In all 10 cases with left lung wrap-around, reconstructed SPECT images showed the hot lateral wall artifact with a mean septal-to-lateral wall count ratio of 0.86. With left lung wrap-around removed in the same 10 patients, reconstructed images did not show hot lateral wall (mean septal-to-lateral wall count ratio = 1.07). The 5 cases without left lung wrap-around did not show hot lateral wall (mean septal-to-lateral wall count ratio = 1.04) and the ratios changed little with the filling of the left lung (mean septal-to-lateral wall count ratio = 1.05). CONCLUSION: Results of our PET-to-SPECT computer simulation model showed that the hot lateral wall artifact found in SPECT myocardial perfusion images was related to the orientation and positions of the left ventricle and the left lung.