RESUMO
CONTEXT: Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined. OBJECTIVE: To assess whether use of 80% oxygen reduces the frequency of surgical site infection without increasing the frequency of pulmonary complications in patients undergoing abdominal surgery. DESIGN, SETTING, AND PATIENTS: The PROXI trial, a patient- and observer-blinded randomized clinical trial conducted in 14 Danish hospitals between October 2006 and October 2008 among 1400 patients undergoing acute or elective laparotomy. INTERVENTIONS: Patients were randomly assigned to receive either 80% or 30% oxygen during and for 2 hours after surgery. MAIN OUTCOME MEASURES: Surgical site infection within 14 days, defined according to the Centers for Disease Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality. RESULTS: Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.72-1.22; P = .64). Atelectasis occurred in 54 of 685 patients (7.9%) assigned to receive 80% oxygen vs 50 of 701 (7.1%) assigned to receive 30% oxygen (OR, 1.11; 95% CI, 0.75-1.66; P = .60), pneumonia in 41 (6.0%) vs 44 (6.3%) (OR, 0.95; 95% CI, 0.61-1.48; P = .82), respiratory failure in 38 (5.5%) vs 31 (4.4%) (OR, 1.27; 95% CI, 0.78-2.07; P = .34), and mortality within 30 days in 30 (4.4%) vs 20 (2.9%) (OR, 1.56; 95% CI, 0.88-2.77; P = .13). CONCLUSION: Administration of 80% oxygen compared with 30% oxygen did not result in a difference in risk of surgical site infection after abdominal surgery. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00364741.
Assuntos
Laparotomia , Oxigenoterapia , Assistência Perioperatória , Complicações Pós-Operatórias/epidemiologia , Atelectasia Pulmonar/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Pneumonia/epidemiologia , Período Pós-Operatório , Insuficiência Respiratória/epidemiologia , Risco , Infecção da Ferida Cirúrgica/epidemiologiaRESUMO
INTRODUCTION: Monitoring of the absorption of irrigating fluid during transcervical resection of the myometrium was studied. Irrigating fluid under pressure was used. Absorption can give symptoms as seen in transurethral resection syndrome. MATERIAL AND METHODS: A method using ethanol labelled irrigation fluid measuring ethanol in expired air was used. Serum natrium and absorbed irrigation fluid estimated by weight was measured. A total of 100 women were included. The investigation was part of the daily routine with varying anaesthetists and nurses. RESULTS: Four patients with an absorption of more than 1200 ml were identified. The end-tidal ethanol and serum natrium deficit were equally accurate in determination of this. In absorption of less than 1200 ml, the serum natrium deficit and end-tidal ethanol were not correlated to absorbed irrigation fluid judged by weighing. CONCLUSION: Determination of the end-tidal ethanol during transcervical resection is recommended as a supplement. The method is non-invasive and simple and can be repeated at any time without interruption of surgery.
Assuntos
Endométrio/cirurgia , Etanol , Monitorização Intraoperatória/métodos , Miométrio/cirurgia , Irrigação Terapêutica , Testes Respiratórios , Etanol/farmacocinética , Feminino , Humanos , Estudos Prospectivos , Sódio/sangue , Sódio/deficiênciaRESUMO
BACKGROUND: A high perioperative inspiratory oxygen fraction may reduce the risk of surgical site infections, as bacterial eradication by neutrophils depends on wound oxygen tension. Two trials have shown that a high perioperative inspiratory oxygen fraction (FiO(2) = 0.80) significantly reduced risk of surgical site infections after elective colorectal surgery, but a third trial was stopped early because the frequency of surgical site infections was more than doubled in the group receiving FiO(2) = 0.80. It has not been settled if a high inspiratory oxygen fraction increases the risk of pulmonary complications, such as atelectasis, pneumonia and respiratory failure. The aim of our trial is to assess the potential benefits and harms of a high perioperative oxygen fraction in patients undergoing abdominal surgery. METHODS AND DESIGN: The PROXI-Trial is a randomized, patient- and assessor blinded trial of perioperative supplemental oxygen in 1400 patients undergoing acute or elective laparotomy in 14 Danish hospitals. Patients are randomized to receive either 80% oxygen (FiO(2) = 0.80) or 30% oxygen (FiO(2) = 0.30) during surgery and for the first 2 postoperative hours. The primary outcome is surgical site infection within 14 days. The secondary outcomes are: atelectasis, pneumonia, respiratory failure, re-operation, mortality, duration of postoperative hospitalization, and admission to intensive care unit. The sample size allows detection of a 33% relative risk reduction in the primary outcome with 80% power. DISCUSSION: This trial assesses benefits and harms of a high inspiratory oxygen fraction, and the trial may be generalizable to a general surgical population undergoing laparotomy. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00364741.