TDNet Discover

In 2016 the World Health Organization (WHO) issued a strong recommendation to administer 80% fraction of inspired oxygen (FiO2) in abdominal surgeries to reduce the occurrence of surgical site infections (SSIs). However, in 2018 the WHO downgraded the recommendation from “strong” to “conditional” due to insufficient supporting evidence and recognition of potential harm. A literature review was conducted to examine the effects of hyperoxia across three domains: SSIs, pulmonary complications, and cardiovascular effects. Research showed there was no consistent reduction in SSI rates associated with administration of high oxygen concentrations, but multiple studies demonstrated significant deleterious effects of hyperoxia on pulmonary and cardiovascular systems. These adverse outcomes included atelectasis, increased postoperative respiratory complications, decreased cardiac output, peripheral vasoconstriction, increased systemic vascular resistance (SVR), higher incidence of acute coronary syndrome and myocardial infarction (MI), and higher mortality rates. With over 4 million abdominal surgeries performed annually in the United States, revisiting the routine use of high FiO2 concentrations could substantially improve patient safety and outcomes and reduce healthcare costs. Despite emerging evidence, many anesthesia providers continue to deliver higher FiO2 concentrations intraoperatively without accounting for individual patient risk factors. Currently, no standardized protocol guides intraoperative oxygen titration, increasing the likelihood of unnecessary oxygen exposure. This project addresses the question: Will providing Certified Registered Nurse Anesthetists (CRNAs) with an educational PowerPoint on the risks vs. benefits of hyperoxia during abdominal surgery cause a decrease in FiO2 concentrations compared to FiO2 concentrations administered before receiving education?