Intra-operative oxygen concentration could affect postoperative morbidity-results of a randomised controlled feasibility trial (PULSE Ox).
- 1Peri-operative and Critical Care Theme, NIHR Southampton Biomedical Research Centre University Hospital Southampton Southampton UK.
- 2Clinical & Experimental Sciences, Faculty of Medicine University of Southampton Southampton UK.
- 3Peninsula Medical School University of Plymouth Plymouth UK.
Abstract
The World Health Organisation recommends that all anaesthetised patients receive FIO₂ 0.8 during surgery to reduce the risk of surgical site infections but did not consider the effect this might have on other clinical outcomes. A Cochrane systematic review concluded that insufficient evidence exists for routinely administering high oxygen concentrations intra-operatively to reduce surgical site infections, and that doing so might increase mortality. A feasibility trial was conducted looking at the feasibility of controlling intra-operative FIO₂ and measuring systemic redox state. Here we explore further clinical outcomes from this study regarding postoperative complications and cognitive recovery. Twenty-eight adult patients undergoing major abdominal surgery for cancer resection were randomly allocated to receive either conservative (FIO₂ = 0.3, n = 8), typical (FIO₂ = 0.55, n = 10) or recommended (FIO₂ = 0.8, n = 10) oxygen throughout anaesthesia. Rates of radiologically reported atelectasis, cognitive recovery and infective postoperative morbidity were all collected up to 7 days after surgery. Total intensive care unit length of stay was also recorded. Higher FIO₂ levels were associated with lower rates of atelectasis - 6 (75%) versus 8 (80%) versus 3 (30%) for FIO₂ = 0.30 versus 0.55 versus 0.80, respectively; p = 0.045. Postoperative cognitive recovery scores (0.7 (3.1) versus -0.1 (2.5) versus -1.8 (3.3), p = 0.277), Postoperative Morbidity Survey infection scores (5 (71%) versus 5 (56%) versus 3 (33%), p = 0.307) and intensive care unit length of stay (3 (2-4) versus 2.5 (2.00-3.75) versus 3 (2.00-5.25) days, p = 0.870) did not differ between groups. Changing the administered intra-operative oxygen concentration may alter postoperative clinical outcomes, and adequately powered clinical studies are urgently needed to investigate the impact of this.
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BibTeX
@article{cumpstey2026intraoperative,
title = {{Intra-operative oxygen concentration could affect postoperative morbidity-results of a randomised controlled feasibility trial (PULSE Ox).}},
author = {A F Cumpstey and J Stygall and A D Clark and M Minnion and H Moyses and D S Martin and M R Edwards and M Feelisch and M P W Grocott},
journal = {Anaesthesia reports},
year = {2026},
month = jul,
doi = {10.1002/anr3.70109},
url = {https://europepmc.org/article/MED/42903451},
note = {CC BY},
}
RIS
TY - JOUR
TI - Intra-operative oxygen concentration could affect postoperative morbidity-results of a randomised controlled feasibility trial (PULSE Ox).
AU - A F Cumpstey
AU - J Stygall
AU - A D Clark
AU - M Minnion
AU - H Moyses
AU - D S Martin
AU - M R Edwards
AU - M Feelisch
AU - M P W Grocott
PY - 2026
DA - 2026/07/01
JO - Anaesthesia reports
DO - 10.1002/anr3.70109
UR - https://europepmc.org/article/MED/42903451
AB - The World Health Organisation recommends that all anaesthetised patients receive FIO₂ 0.8 during surgery to reduce the risk of surgical site infections but did not consider the effect this might have on other clinical outcomes. A Cochrane systematic review concluded that insufficient evidence exists for routinely administering high oxygen concentrations intra-operatively to reduce surgical site infections, and that doing so might increase mortality. A feasibility trial was conducted looking at the feasibility of controlling intra-operative FIO₂ and measuring systemic redox state. Here we explore further clinical outcomes from this study regarding postoperative complications and cognitive recovery. Twenty-eight adult patients undergoing major abdominal surgery for cancer resection were randomly allocated to receive either conservative (FIO₂ = 0.3, n = 8), typical (FIO₂ = 0.55, n = 10) or recommended (FIO₂ = 0.8, n = 10) oxygen throughout anaesthesia. Rates of radiologically reported atelectasis, cognitive recovery and infective postoperative morbidity were all collected up to 7 days after surgery. Total intensive care unit length of stay was also recorded. Higher FIO₂ levels were associated with lower rates of atelectasis - 6 (75%) versus 8 (80%) versus 3 (30%) for FIO₂ = 0.30 versus 0.55 versus 0.80, respectively; p = 0.045. Postoperative cognitive recovery scores (0.7 (3.1) versus -0.1 (2.5) versus -1.8 (3.3), p = 0.277), Postoperative Morbidity Survey infection scores (5 (71%) versus 5 (56%) versus 3 (33%), p = 0.307) and intensive care unit length of stay (3 (2-4) versus 2.5 (2.00-3.75) versus 3 (2.00-5.25) days, p = 0.870) did not differ between groups. Changing the administered intra-operative oxygen concentration may alter postoperative clinical outcomes, and adequately powered clinical studies are urgently needed to investigate the impact of this.
SN - 2637-3726
ER -