Résumé :
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[BDSP. Notice produite par INIST-CNRS Ep9uR0xK. Diffusion soumise à autorisation]. Context : Surgical site infection (SSI) in the general surgical population is a significant public health issue. The use of a high fractional inspired concentration of oxygen (FIO2) during the perioperative period has been reported to be of benefit in selected patients, but its role as a routine intervention has not been investigated. Objective : To determine whether the routine use of high FIO2 during the perioperative period alters the incidence of SSI in a general surgical population. Design, Setting, and Patients : Double-blind, randomized controlled trial conducted between September 2001 and May 2003 at a large university hospital in metropolitan New York City of 165 patients undergoing major intra-abdominal surgical procedures under general anesthesia. Interventions : Patients were randomly assigned to receive either 80% oxygen (FIO2 of 0.80) or 35% oxygen (FIO2 of 0.35) during surgery and for the first 2 hours after surgery. Main Outcome Measures : Presence of clinically significant SSI in the first 14 days after surgery, as determined by clinical assessment, a management change, and at least 3 prospectively defined objective criteria. Results The study groups were closely matched in a large number of clinical variables. The overall incidence of SSI was 18.1%. In an intention-to-treat analysis, the incidence of infection was significantly higher in the group receiving FIO2 of 0.80 than in the group with FIO2 of 0.35 (25.0% vs 11.3% ; P=02). FIO2 remained a significant predictor of SSI (P=03) in multivariate regression analysis. Patients who developed SSI had a significantly longer length of hospitalization after surgery (mean [SD], 13.3 [9.9] vs 6.0 [4.2] days ; P<. conclusions : the routine use of high perioperative fio2 in a general surgical population does not reduce overall incidence ssi and may have predominantly deleterious effects. patients should continue to receive oxygen with cardiorespiratory physiology as principal determinant.>
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