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Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
Published on: December 5, 2025
RETHINKING INTRAOPERATIVE OXYGEN: VARIABILITY, RISK, AND THE PATH TO EVIDENCE-BASED PRACTICE
1Nashville, Tennessee.
Abstract:
Oxygen administration is essential for safe anesthesia, but excess oxygen administration perturbs biochemistry and physiology. Understanding the impact of variable oxygen tension on mechanisms of perioperative organ injury and patient outcomes drives our research program. In a study of 367,000 surgical patients, the fraction of inspired oxygen varied widely from 100% to air (21%). The medical center and anesthesiologist who cared for the patient accounted for far more variability than patient or procedure factors. This non-patient-centered variation identifies an opportunity to determine the optimal approach to intraoperative oxygen administration. In preclinical studies, high oxygen increased kidney and brain injury and dysfunction; in clinical trials, surgical patients randomly assigned to hyperoxia had increased concentrations of markers of oxidative damage and impaired vascular reactivity compared to patients assigned to normoxia. We now have an opportunity to determine best practices for oxygen administration during surgery in a large multicenter clinical trial.
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