New WHO recommendations

[urge]

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Has anyone seen the new surgical site infection recommendations?

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30402-9/fulltext

They are all homeopathic recommendations with very little data behind it. Strikingly, hyperoxemia with FIO2 of 80% intraop and post op for several hours received "strong recommendation" despite conflicting evidence.

Discuss.

 

[dhb]

Don't have access...

 

[Noyac]

I'm not sure I'm following you here. It all seems pretty standard stuff to me.
The higher FiO2 is maybe a debateable recommendation but 0.80% isn't gonna hurt anything. Unless you want to talk about atelectasis, etc.

 

[urge]

I'm not sure I'm following you here. It all seems pretty standard stuff to me.
The higher FiO2 is maybe a debateable recommendation but 0.80% isn't gonna hurt anything. Unless you want to talk about atelectasis, etc.

I find it irresponsible for such a revered internatiomal society that pretty much sets policiy to strongly recommend something based on questionable data.

 

[urge]

https://www.ncbi.nlm.nih.gov/pubmed/14709579


This paper says it actually leads to more infections with a p value of 0.02

 

[Noyac]

Ok.
Have you met the TJC? 😕

 

[urge]

Don't have access...

https://pbs.twimg.com/media/CwRA0KaXgAEPWrr.jpg

These are the tables with the summary.

 

[Mad Jack]

https://www.ncbi.nlm.nih.gov/pubmed/14709579


This paper says it actually leads to more infections with a p value of 0.02

https://www.ncbi.nlm.nih.gov/pubmed/27128538
It also has a higher risk of cardiovascular complications. These recommendations are basically pants-on-head ******ed if they're recommending blanket 0.8 FiO2.

 

[Aether2000]

We may be out of the UN soon anyway so WHO recommendations will have no weight in the US ;-)

 

[facted]

What mechanism could there be for increased ACS with increased intraop FIO2? Doesn't make a ton of sense. Also, that study is a post-hoc analysis of an original study. Kinda like the secondary analysis of engima showing increased cardiac issues with nitrous which were totally rebuked with ENGIMA-2. Just sayin..

Lots of studies support the reduction of SSI's with 80% FIO2:

https://www.ncbi.nlm.nih.gov/pubmed/23719611
https://www.ncbi.nlm.nih.gov/pubmed/25060545
https://www.ncbi.nlm.nih.gov/pubmed/16249417

 

[BLADEMDA]

I typically use 55%-60% FiO2 which is still "high FiO2" based on some studies:

http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1917849

 

[deleted162650]

My first gig had no pipeline air in the OR's. Every pt got run on 100% O2. 😕

 

[sigrhoillusion]

My first gig had no pipeline air in the OR's. Every pt got run on 100% O2. 😕

Sounds like a litigation nightmare for an ENT airway fire...

 

[deleted162650]

Sounds like a litigation nightmare for an ENT airway fire...

For those cases we just made sure to have a full air cylinder on the back of the machine. We weren't stupid.

 

[Noyac]

I typically use 55%-60% FiO2 which is still "high FiO2" based on some studies:

http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1917849

Same here.

 

[IlDestriero]

I can't wait for the next SSI bundle! And a town hall meeting to discuss it no doubt. 🙂


--
Il Destriero