Zuurstof toegevoegd aan operatieve ingreep van darmkanker en rectumkanker vermindert de kans op wondinfecties met meer dan de helft.

Meer artikelen over ozontherapie - zuurstoftherapie vindt u onder:

https://kanker-actueel.nl/NL/ozon-zuurstoftherapie.html

16 februari 2012: klik hier voor een uitleg over ozontherapie. Dit is de website van een van de klinieken in Nederland die ozontherapie toepast, maar we hebben geen enkele binding met deze kliniek en ozontherapie is ook elders in Nederland verkrijgbaar. Maar hier wordt helder uitgelegd wat ozontherapie is en hoe het wordt toegepast.

28 oktober 2005: Bron: JAMA. 2005 Oct 26;294(16):2035-42. and Medscape

Wanneer extra zuurstof enkele uren voor en tijdens een operatie van darmkanker en/of rectumkanker wordt toegevoegd dan vermindert dat het risico op wondinfecties met meer dan de helft. Dit blijkt uit een gerandomiseerde dubbelblinde studie onder 300 darmkankerpatiënten in een periode van twee jaar. Ozontherapie is natuurlijk al langer bekend maar hier wordt opnieuw maar weer eens aangetoond dat oxygen = ozon = zuurstof een extra helende waarde kan hebben, ook bij behandelingen van kanker. Achtereenvolgens het abstract van de studie en een artikel uit Medscape hierover.

JAMA. 2005 Oct 26;294(16):2035-42.

Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial.

Belda FJ, Aguilera L, Garcia de la Asuncion J, Alberti J, Vicente R, Ferrandiz L, Rodriguez R, Company R, Sessler DI, Aguilar G, Botello SG, Orti R; Spanish Reduccion de la Tasa de Infeccion Quirurgica Group.

Department of Anesthesiology and Critical Care, Hospital Clinico Universitario, Valencia, Spain. fjbelda@uv.es

CONTEXT: Supplemental perioperative oxygen has been variously reported to halve or double the risk of surgical wound infection. OBJECTIVE: To test the hypothesis that supplemental oxygen reduces infection risk in patients following colorectal surgery.

DESIGN, SETTING, AND PATIENTS: A double-blind, randomized controlled trial of 300 patients aged 18 to 80 years who underwent elective colorectal surgery in 14 Spanish hospitals from March 1, 2003, to October 31, 2004. Wound infections were diagnosed by blinded investigators using Centers for Disease Control and Prevention criteria. Baseline patient characteristics, anesthetic treatment, and potential confounding factors were recorded.

INTERVENTIONS: Patients were randomly assigned to either 30% or 80% fraction of inspired oxygen (FIO2) intraoperatively and for 6 hours after surgery. Anesthetic treatment and antibiotic administration were standardized.

MAIN OUTCOME MEASURES: Any surgical site infection (SSI); secondary outcomes included return of bowel function and ability to tolerate solid food, ambulation, suture removal, and duration of hospitalization.

RESULTS: A total of 143 patients received 30% perioperative oxygen and 148 received 80% perioperative oxygen. Surgical site infection occurred in 35 patients (24.4%) administered 30% FIO2 and in 22 patients (14.9%) administered 80% FIO2 (P=.04). The risk of SSI was 39% lower in the 80% FIO2 group (relative risk , 0.61; 95% confidence interval , 0.38-0.98) vs the 30% FIO2 group. After adjustment for important covariates, the RR of infection in patients administered supplemental oxygen was 0.46 (95% CI, 0.22-0.95; P = .04). None of the secondary outcomes varied significantly between the 2 treatment groups.

CONCLUSIONS: Patients receiving supplemental inspired oxygen had a significant reduction in the risk of wound infection. Supplemental oxygen appears to be an effective intervention to reduce SSI in patients undergoing colon or rectal surgery.Trial Registration ClinicalTrials.gov Identifier: NCT00235456.

PMID: 16249417 [PubMed - in process]

Supplemental Oxygen May Reduce Surgical Site Infections CME
News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP

Oct. 25, 2005 — Supplemental oxygen can reduce surgical site infections (SSI), according to the results of a double-blind, randomized trial published in the Oct. 26 issue of JAMA. The editorialists suggest that surgeons should encourage use of higher oxygen tensions.

"Supplemental perioperative oxygen has been variously reported to halve or double the risk of surgical wound infection," write F. Javier Belda, MD, PhD, from the Hospital Clínico Universitario in Valencia, Spain, and colleagues from the Spanish Reduccion de la Tasa de Infeccion Quirurgica Group. "Infection risk depends on tissue oxygen partial pressure and, therefore, interventions that increase tissue oxygen may reduce infection risk."

From March 1, 2003, to Oct. 31, 2004, at 14 Spanish hospitals, 300 patients aged 18 to 80 years who underwent elective colorectal surgery were randomized to receive either 30% or 80% fraction of inspired oxygen (FIO2) intraoperatively for six hours after surgery. Anesthetic treatment and antibIOtic administratIOn were standardized, and wound infectIOns were diagnosed by blinded investigators using the Centers for Disease Control and PreventIOn criteria. Primary endpoints were any SSI, and secondary endpoints were return of bowel functIOn and ability to tolerate solid food, ambulatIOn, suture removal, and duratIOn of hospitalizatIOn.

SSI occurred in 35 (24.4%) of 143 patients administered 30% FIO2 and in 22 (14.9%) of 148 patients administered 80% FIO2 (P = .04). Compared with the group receiving 30% FIO2, the group receiving 80% FIO2 had a 39% lower risk of SSI (relative risk , 0.61; 95% confidence interval , 0.38 - 0.98). After adjustment for important covariates, the RR of infectIOn in patients receiving supplemental oxygen was 0.46 (95% CI, 0.22 - 0.95; P = .04). The secondary outcomes were not significantly different in the two treatment groups.

"Patients receiving supplemental inspired oxygen had a significant reductIOn in the risk of wound infectIOn," the authors write. "Supplemental oxygen appears to be an effective interventIOn to reduce SSI in patients undergoing colon or rectal surgery."

Study limitatIOns include baseline infectIOn rate roughly twice that found in a prevIOus study, possible effect of the diagnostic method used to describe infectIOn on the reported results, and consideratIOn only of infectIOns that occurred in the first 15 days after surgery.

"Supplemental 80% FIO2 during and for six hours after major colorectal surgery reduced postoperative wound infectIOn risk by roughly a factor of two," the authors conclude. "This result is consistent with most available in vitro data and one other appropriately designed randomized controlled trial. Supplemental oxygen appears to confer few risks to the patient, has little associated cost, and should be considered part of ongoing quality improvement activities related to surgical care."

The participating centers, Air-Liquide Medicinal in Spain, Air-Liquide Santé in France, the NatIOnal Institutes of Health, the Gheens FoundatIOn, and the Joseph Drown FoundatIOn have disclosed that they funded this study. The authors have disclosed no financial relatIOnships.

In an accompanying editorial, E. Patchen Dellinger, MD, from the University of Washington School of Medicine in Seattle, and colleagues, note that the pooled data from all three studies concerning this interventIOn do not show any risk associated with increased oxygen concentratIOns but rather suggest possible benefit.

"Surgeons should not wait for this issue to be resolved before moving forward with this simple, inexpensive, and low-risk interventIOn while at the same time monitoring both its effectiveness in the community at large and the chance that its use will have unintended consequences," the editorialists write. "Surgeons should encourage the broader use of higher oxygen tensIOns for their patients undergoing major abdominal procedures and be more involved in quality improvement initiatives aimed at reducing SSI."

Dr. Dellinger and colleagues have disclosed no financial relatIOnships.

JAMA. 2005;294:2035-2042, 2091-2092

Learning Objectives for This Educational Activity Upon completion of this activity, participants will be able to: List strategies to reduce SSI. Identify outcomes improved with higher concentrations of oxygen administered during surgery and in the postoperative period. Clinical Context SSI doubles the length of hospital stay for patients with infectIOns compared with those who do not have infectIOns. In additIOn, SSI can double the risk of mortality after surgery. An editorial by Dellinger, which accompanies the current article, describes some means to prevent SSI. These include the proper selectIOn and timing of prophylactic antibIOtics, clipping rather than shaving of hair, maintenance of a regular temperature, homeostasis of glucose levels, and appropriate surgical technique.

The issue of whether a higher concentratIOn of inhaled oxygen can also prevent SSI is controversial. While some research has demonstrated a benefit to such therapy, a study by Pryor and colleagues that was published in the Jan. 7, 2004, issue of JAMA demonstrated that intraoperative use of a FIO2 of 80% was associated with an absolute risk increase of SSI of 13.7% compared with a FIO2 of 30%. The main study result was unchanged after multivariate analysis.

The current article again compares administratIOn of FIO2 of 80% and 30% in a standardized group of patients undergoing colorectal surgery.

Study Highlights
The study cohort comprised 300 patients from 14 hospitals in Spain. All subjects were undergoing colorectal resectIOn, but patients with planned laparoscopic surgery were excluded from study participatIOn.
A standard procedure was followed before, during, and after surgery for all participants. All subjects had mechanical bowel preparatIOn without antibIOtics or antiseptics. AntibIOtic prophylaxis was provided with metronidazole and a cephalosporin. Participants were randomized to receive a FIO2 of either 30% or 80% during surgery and for 6 hours postoperatively.

All subjects underwent a preoperative evaluatIOn for the risk of SSI. Study outcomes were measured by blinded investigators. The main study outcome was the rate of SSI. In additIOn, the authors examined wound healing, postoperative glucose levels, and blood loss. Follow-up was continued until postoperative day 15.

9 subjects were excluded from the main analysis, leaving 291 patients with data from the research protocol. Baseline data were similar between groups, with the exceptIOn that there was a higher percentage of women in the 80% FIO2 group. The mean age of participants was 63 years old, and 86% of all subjects were having surgery for colon cancer. The most common procedures performed were hemicolectomy and sigmoid anterIOr resectIOn.

Rates of SSI were 24.4% in the 30% FIO2 group vs 14.9% in the 80% FIO2 group. This represented a RR reductIOn of 39% for the 80% FIO2 group. Subjects with SSI had a longer time until ambulatIOn, staple removal, and hospital discharge. There was a trend toward better wound healing in the 80% FIO2 group, but this result was not statistically significant. The number of patients receiving transfusIOns and the number of units transfused per patient were similar between the 2 groups. Postoperative glucose levels were also similar between groups. After multivariate analysis, only the FIO2 and coexisting respiratory tract infectIOn significantly affected the risk of SSI.

Pearls for Practice
Proper selectIOn and timing of prophylactic antibIOtics, clipping rather than shaving of hair, maintenance of a regular temperature, homeostasis of glucose levels, and appropriate surgical technique can prevent SSI. The current study demonstrates that a FIO2 of 80% during and after colorectal surgery reduces the risk of SSI compared with a FIO2 of 30%.