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April 28, 2004

Supplemental Oxygen and Risk of Surgical Site Infection

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(16):1956. doi:10.1001/jama.291.16.1957-c

To the Editor: Dr Pryor and colleagues1 did not measure oxygenation of peri-incisional fatty tissue, which is an important mediator of wound-space oxygenation and the resulting oxygen-dependent killing of bacteria by local neutrophils.2 To isolate a potential effect of increased inspired oxygen on local wound defenses, it is also important to prevent peripheral vasoconstriction, both by volume expansion and also by warming to avoid blunting of reflex vasoconstriction as patients emerge from general anesthesia.3 Unfortunately, Pryor et al did not describe details of fluid management or warming. Furthermore, simple volume expansion may improve fat oxygenation by as much as 25% without administration of extra oxygen.4 Inadequate pain control may also play an important role in stimulating sympathetic discharge; the resultant peripheral vasoconstriction need not be massive to influence fat perfusion and thus oxygenation.5

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