Postoperative wound infections (PRI) double the length of hospital stay and increase the risk of death after surgery. At present, there is insufficient data to clearly state that a high concentration of breathing oxygen can reduce the incidence of PID: while some studies demonstrate the benefits of such therapy, a study published in the issue of January JAMA in 2004, showed that intraoperative administration of 80% of the FiO2 fraction was associated with an absolute risk of PRI increase of 13.7%, against 30% of FiO2. In a new randomized double-blind trial based on 14 hospitals in Spain, 300% of patients who underwent colorectal resection were allocated 30% or 80% of the oxygen fraction of FiO2. The results of the study showed that the appointment of supplemental oxygen can reduce the incidence of postoperative wound infections, and surgeons based on this data may be recommended to use oxygen at higher concentrations.

According to various sources, additional oxygen during surgery can halve or double the risk of infection from surgical wounds, says Dr. F. Kh. Belda (F. Javier Belda) from the University Hospital of Valencia, Spain, and colleagues from the Spanish Group Reduccion de la Tasa de Infeccion Quirurgica. It is known that the risk of infection depends on the partial pressure of oxygen in the tissues, therefore, an increase in the concentration of tissue oxygen can help reduce the risk of developing PRI.

Between March 1, 2003 and October 31, 2004, in 14 Spanish hospitals, 300 patients aged 18 to 80 who underwent planned colorectal interventions were randomized to participate in the study and received 30% or 80% of the fraction inhaled oxygen (FiO2) intraoperatively and within 6 hours of surgery. All participants underwent mechanical preoperative bowel preparation without the use of antibiotics or antiseptics. For the purpose of perioperative antibacterial prophylaxis, metronidazole and cephalosporins have been prescribed. Anesthetics and antibiotics were prescribed according to standard protocols adopted in hospitals. The risk of developing postoperative wound infections during the preoperative period has been recorded by "blind" researchers according to the criteria of the United States Centers for Disease Control and Prevention (CDC). The main results of the study were all PRI, secondary outcomes were assessed by restoration of bowel function and ability to transport solid food, ambulatory transfer, removal of sutures and length of time. hospitalization.

Postoperative wound infections were diagnosed in 35 (24.4%) of the 143 patients who received a 30% fraction of FiO2 and in 22 (14.7%) of the 148 patients who received an 80% fraction of FiO2 prescribed. In the group receiving the 80% FiO2 fraction, the risk of PRI was 39% lower (relative risk 0.61; 95% CI, 0.38-0.98). After adjusting for the significant variables, the relative risk of infection in patients receiving supplemental oxygen decreased to 0.46 (95% CI, 0.22-0.95; p = 0.04). The secondary outcomes were slightly different in the two randomization groups.

Thus, the appointment of additional oxygen has significantly reduced the risk of developing PRI, which allows us to consider this method as effective in reducing infectious complications in patients operated on in the colon or rectum.

Limitations of the study include the fact that the initial infection rate was almost double that determined in the previous study, possibly due to the approach used to record infections based on the advisory according to patient records, and that only infections that developed within the first 15 were recorded days after surgery.

The commentary to the article indicates that the results are consistent with the available in vitro studies and other randomized controlled clinical trials. Additional oxygen, of course, does not pose a danger to the patient, the cost of the procedure is low, and therefore the appointment of additional oxygen should be included in the complex of measures for the management of patients who require surgery.

In an accompanying article, Professor P. Dallinger of the Faculty of Medicine at the University of Washington, Seattle, United States (Professor P. Dellinger visited USA several times and spoke at the IACMAC international conferences) notes that the combined data from three studies in this area have not revealed any significant significance. the risk associated with the appointment of higher oxygen concentrations and evidence in favor of this method of treatment of surgical patients. He also believes that surgeons should not wait until the use of the method is officially recognized, but should start using this simple, inexpensive and relatively safe approach, while monitoring its effectiveness and its possible undesirable consequences. Surgeons should introduce wider use of increased oxygen levels in the treatment of patients requiring radical abdominal procedures, as well as promote the introduction of new treatment methods aimed at reducing postoperative infectious complications.

At the same time, in the commentary to the article, it is rightly pointed out that, with new approaches to reduce the incidence of postoperative wound infections, it should not be forgotten that an adequate choice of modes of antibiotic prophylaxis, cutting and not shaving the hair, maintaining a constant temperature and glucose level contribute to a reduction in the risk of their development. as well as the appropriate surgical technique.