Cardiothoracic & vascular anesthesia
Impact of Intraoperative Hyperoxia Versus Normoxia on Mortality and Organ Injury in Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Clinical Trials
Authors' conclusion
Compared with normoxia, hyperoxia during cardiac surgery does not impact in-hospital or 30-day mortality but is associated with worsening physiological and biochemical parameters.
Study context
- Population
- Patients undergoing cardiac surgery with CPB or off-pump procedures
- Participants
- 2,001 patients · 19 randomized clinical trials (RCTs)
- Comparison
- Intraoperative hyperoxia vs normoxia
- Hyperoxian = 982
- Outcome
- In-hospital and 30-day mortality
Methodological detailstrial sequential analysis, subgroup analysis by oxygenation definition (PaO₂-based v FiO₂-based)
- Trial sequential analysis
- Subgroup analysis by oxygenation definition (PaO₂-based v FiO₂-based)
Pooled result
As reported in the abstract
In-hospital mortality not different between hyperoxia and normoxia: 9/798 [1.1%] v 10/799 [1.3%]
RR 0.84, 95% CI 0.36 to 1.94
p = 0.684
30-day mortality not different between hyperoxia and normoxia: 1/282 [0.4%] v 4/280 [1.4%]
RR 0.41, 95% CI 0.08 to 2.28
p = 0.311
Further pooled results
Postoperative PaO2/FiO2 ratio
- Higher in the normoxia group
- MD −31.49, 95% CI −47.13 to −15.85, p < 0.01
Creatine kinase-MB
- Higher in the hyperoxia group
- SMD 1.65, 95% CI 0.12 to 3.18, p = 0.03
Malondialdehyde
- Higher in the hyperoxia group
- SMD 3.77, 95% CI 2.99 to 4.55, p < 0.01
Original publication
Impact of Intraoperative Hyperoxia Versus Normoxia on Mortality and Organ Injury in Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Clinical Trials. J Cardiothorac Vasc Anesth. Published 22 September 2025. doi:10.
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