Die Silikon-beschichtete Polyester-Prothese

Background

Herein we report on the development of a multifunctional, silicone-coated polyester graft.

Methods

Normal polyester prostheses were coated with silicone. Afterwards, the surface was modified with different functional groups. In addition, substances with the aim of elution were incorporated into the bulk of the silicone. We analyzed these grafts regarding their physical and biological properties.

Results

Physical and biological characteristics (such as density, compliance, and stiffness) of a polyester graft coated with 16–20 mg silicone/cm² are comparable to a normal prosthesis. In surface modification, polyvinylalcohol and phosphocholine-modified materials showed advantages regarding thrombogenicity. The eluted molecules could be found preferentially in the medium used (ASS) or in the tissue adjacent to the bypass (Sudan red, sirolimus, and another immunosuppressive drug). In the animal study, the elution of the substances was demonstrated by the effect on the intimal hyperplasia.

Conclusions

The prosthesis presented in this paper may be modified in many ways. Besides optimizing the hemocompatibility, the elution of molecules offers a tremendous tool for local drug release.     

Der iliofemorale Crossover-Bypass kombiniert mit intraoperativer aortoiliakaler Stenteinlage

Objective: To study the outcome of treating biiliacal aortoiliac occlusive disease by combined procedures consisting in placement of an iliofemoral crossover bypass and aortoiliac stenting for inflow improvement. Design: Retrospective study of 24 patients with aortoiliac occlusive disease who were treated with this combined endovascular procedure. Materials: From March 1995 to July 1998 24 patients underwent this combined procedure. Mean age was 63.8 years (range 48–73 years). All aortoiliac stents were implanted intraoperatively followed by placement of an iliofemoral crossover bypass. In case of stenosis of the deep femoral artery, a femoral-femoral crossover bypass was preferred. Results: In the mean follow-up period of 42 months, primary assisted patency was 100%. Clinical signs of arterial occlusive disease were decreased to Fontaine stage IIa in all cases. Conclusions: This experience demonstrates that iliofemoral crossover bypass combined with simultaneous stent implantation for inflow improvement is an effective and low invasive treatment in patients with extensive aortoiliac occlusive disease.     

Progress in the treatment of thoracic aortic aneurysms

Progress in the management of thoracic aortic aneurysm includes the following aspects:

1. the concepts of the disease itself, which is frequently generalized so that the second most common cause of late death is rupture of another aneurysm;
2. the diagnostic techniques used: computed tomographic scanning as well as aortography;
3. the medical treatment: with beta blockade and antihypertensive drugs in stable aortic injury in the patient with multiple critical injuries;
4. that hypothermic circulatory arrest with cardiopulmonary bypass and brain temperatures down to 16–20°C has increased successful aortic arch replacement from 50–75% to over 90%;
5. that rapid autologous transfusion by means of a modified Hemonetics machine can collect and process a unit of shed blood in 2–3 minutes and has reduced transfusion requirements by more than half;
6. the vigorous treatment of both consumptive and dilutional coagulopathies;
7. the new reconstructive techniques: involving composite valve graft replacement of the aortic valve, root, and arch as well as coronary artery reattachment;
8. that the use of viable tissue flaps in the treatment of infected aortic grafts as well as intravenous and local irrigation with antibiotics was successful in 8 of 9 of our cases;
9. that graft replacement with intensive antibiotic therapy was effective in 19 of 22 of our patients with mycotic thoracic aortic aneurysm.

     

Wound healing in forefoot amputations: The predictive value of toe pressure

A retrospective study of 136 men undergoing forefoot amputation was done to test the hypothesis that preoperative toe pressure (TP) could predict the likelihood of wound healing. Demographic data included age, smoking history, diabetes mellitus (DM), hypertension, hyperlipidemia, and coronary artery disease. Clinical data included infection, preoperative arterial Doppler data, TP, wound disposition, concomitant revascularization (REV), and healing outcome. Among diabetics, no primary amputation healed with a preoperative TP <38 mm Hg. Among REV diabetics, no healing occurred with a TP <40 mm Hg after bypass, but no failures occurred either with a TP >68 mm Hg or an increase in TP >30 mm Hg after bypass. Nondiabetic patients exhibited no threshold TP values. Univariate analysis revealed that DM and REV were significantly different in the healed (N=83) vs. nonhealed (N=53) populations ( p =0.027 and 0.034). In healed patients, mean TP (71.8 ± 3.5 mm Hg SEM) was significantly higher than in nonhealed patients (45.1 ± 4.3 mm Hg SEM,p =0.000). Logistic regression analysis identified age >60 years (p =0.03), DM (p =0.003), preoperative TP ( p <0.001), and REV ( p <0.001) as significant independent predictors of forefoot amputation healing. Healing probability was calculated and plotted vs. TP for subpopulations based on age, DM, and REV status for both primary forefoot amputation and amputation concomitant with bypass. In this study population, therefore, preoperative TP appeared to be a useful clinical tool for predicting the healing potential of both primary forefoot amputations and amputations plus concomitant bypass for any given patient.     

Externe Verst?rkung varik?ser Venen in der Gef?sschirurgie

Background

Autologous veins are the material of choice for peripheral bypass surgery. Varicose veins are deemed to be inadequate because of the risk of increasing dilatation or rupture. In this paper different possibilities of external reinforcement for varicose veins are discussed.

Patients, materials and methods

From 1^st November 2002 to 28^th March 2010 a total of 24 patients with peripheral arterial disease underwent infrainguinal bypass surgery because of residual pain or gangrene. In all patients externally reinforced varicose veins were implanted as bypass grafts. In 8 cases a customary PTFE prosthesis was used for the external reinforcement, in 5 patients mesh tubing made of steel alloy (Biocompound-graft?) and in 11 patients a porous polyester stent (ProVena?) was used. The follow-up of the patients ranged between 2 and 86 months (mean 40 months).

Results

In four patients thrombosis occurred in the bypass early postoperatively and amputation was necessary in two of these patients. During the follow-up three additional thromboses occurred in the bypass. The secondary patency rate after 1 year was 83% and over 90% of the limbs could be saved. Of the patients six died with a working bypass and preserved extremities.

Conclusion

The use of externally reinforced varicose veins seems to offer an alternative to synthetic grafts with good results in a selected cohort of patients.     

Auswirkung von Aprotinin und Tranexamsäure auf die Fibrinolyse und Thrombinbildung bei extrakorporaler Zirkulation

Objective: Antifibrinolytic drug therapy has proved to be effective in reducing blood loss associated with cardiac surgery and cardiopulmonary bypass (CPB). Concerns remain regarding the risk of enhancing thrombosis. In the present study we investigated the effect of aprotinin (AP) and tranexamic acid (TA) on fibrinolysis and thrombin generation during CPB. Methods: 60 patients undergoing coronary artery bypass graft surgery were randomised in 3 groups. They received either aprotinin (“high-dose-scheme”), tranexamic acid (2 g/h) or no antifibrinolytic therapy (control group). Collection of blood was performed at 7 pre-, intra- and postoperatively predetermined intervals. Fibrinolytic activity was determined by measuring concentrations of D-dimer, thrombin generation by the measurement of thrombin-antithrombin III complex (TAT). Results: There was no significant increase of D-dimers in the AP or TA group. D-dimer concentration in the control group increased significantly after starting CPB. Comparing with the control group, thrombin generation in the AP group was significant less, while TA group produced significantly higher values. Conclusion: After the administration of AP for cardiac surgery we observed reductions in both intraoperative fibrinolysis and thrombin generation. In case of TA suppression of fibrinolytic activity in the absence of concomitant reduction in thrombin generation occurred. These results suggest that TA could potentiate a hypercoagulable state with the risk of thrombosis in the perioperative setting.     

Clinico-functional results of constrained knee endoprostheses

Aim of the study. To assess the clinical and functional outcome after implantation of a constrained knee arthroplasty. Material and methods. 14 patients with a revision of the primary prostheses with constrained knee arthroplasties (“Genesis constrained” and “Blauth”) were evaluated in the operated and non operated leg at an average follow-up of 8.5 months (range 6.5 to 61.4 months). The study included clinical examinations as well as gait analysis and surface electromyography. The results were compared with a group of healthy volunteers. The clinical examinations were scored with the HSS, the Knee Society Score, the Tegner Activity Score, the Patella Score and the Visual Analogue Scale. Gait analysis was performed with a three dimensional motion analysis system. Surface electromyography was evaluated bilaterally from the rectus femoris, vastus medialis and lateralis, semitendinosus, biceps femoris (long head), tibialis anterior and gastrocnemius (medial head). Results. The comparison between the healthy volunteers and the patients showed significant functional deficits in the patient group. The electromyography demonstrated significantly lower peak amplitudes in 5 of 7 muscles. In all parameters – except for knee extension – gait analysis resulted in significant differences between the patient and control group. The comparison between the operated and non operated leg showed a significant difference only for knee extension. The patients revealed a bilateral functional deficit so that gait symmetry was preserved. Conclusion. The presented results indicate that the functional deficits may be caused by preoperative deficits and are not only due to the operation. It can be supposed that the gastrocnemius is more important because of the high correlation with the clinical results. The value of pre- and postoperative rehabilitation programs to prevent postoperative functional deficits can be concluded.     

Komplexe distale Bypasschirurgie mit der Brückenplastik nach Deutsch und der denaturierten humanen Umbilikalvene (HUV)

Introduction

Tibial and pedal reconstructions in the absence of suitable autologous vein still present a major challenge in surgical therapy of critical lower limb ischemia. Besides the widely used synthetic vascular prostheses, small caliber vascular conduits of biological origin, which may be combined with residual autologous vein, are available. Bypass run-off can be optimized by means of distal sequential anastomoses. The results of a consecutive series of sequential bypasses applying the bridge technique developed by Deutsch in combination with denaturated human umbilical vein (HUV) are reported.

Methods

In 36 limbs with critical ischemia and inadequate length of autologous vein, a bridge graft between the distal recipient vessels using residual vein was combined with a central HUV prosthetic donor graft. Patients were followed-up in terms of bypass function, limb salvage, changes in distal run-off and possible biodegeneration of the HUV.

Results

Primary and secondary bypass graft patencies were 54% and 79%, respectively, with a limb salvage rate of 92% after 36 months. Despite consecutive partial occlusion of the bypass, foot perfusion remained unimpaired in seven cases. Additional intervention was necessary in seven bypasses in order to maintain graft patency. Degenerative changes in the biological graft could not be detected during follow-up.

Conclusion

The bridge graft technique developed by Deutsch using a distal sequential autologous vein bridge provides excellent long-term results in terms of bypass patency and limb salvage when HUV is used as a central part of the construction.     

Renal endarterectomy vs. bypass for combined aortic and renal reconstruction: Is there a difference in clinical outcome?

Are there differences in the patient characteristics and clinical outcome for transaortic renal endarterectomy vs. bypass grafting when either technique is combined with infrarenal aortic replacement for occlusive or aneurysmal disease? Two common perceptions persist: (1) combined aortic and renal procedures have a high risk and (2) bypass is easier and safer than endarterectomy. To address these controversies we compared 52 consecutive patients undergoing concomitant aortic and renal reconstruction between 1987 and 1991: 26 with bypass and 26 with endarterectomy. Bypass patients were older (70 vs. 64 years,p=0.001),had more extensive plaque extending into the distal renal artery and more severe baseline azotemia (creatinine=2.6 vs 1.7 mg/dl,p=0.01),more clinically evident coronary heart disease (89% vs. 56%,p=0.001),and a greater need for nephrectomy of a small nonfunctional pressor kidney (23% vs. 0%) than endarterectomy patients. In contrast, endarterectomy patients more commonly required aortic replacement for occlusive disease than for an aortic aneurysm (endarterectomy: 65% vs. 35%; bypass: 19% vs 81%,p=0.002)and tended to require more intraoperative technical revisions (12% vs. 4%) than bypass patients. Both groups, however, experienced no operative mortality, had similar cardiorespiratory morbidity, and achieved equal improvement in hypertension (69% vs. 65%). Bypass patients, who already had more severe preoperative azotemia than endarterectomy patients, showed less improvement in the creatinine level (Cr=2.1 vs. 1.4 mg/dl,p=0.01)and had greater need for late dialysis (30% vs. 4%,p=0.01).Only one patient on dialysis had graft occlusion. We conclude that patients requiring bypass are generally at a more advanced stage of both cardiovascular and renal disease and have a greater need for late dialysis than was previously recognized. Transaortic endarterectomy is a safe and effective choice in patients with bilateral orificial renal atheroma and aortic occlusive disease. Both procedures currently carry a lower operative risk than was previously predicted and have equal effectiveness in controlling renovascular hypertension.     

Abdominoperineal excision of the rectum: A prospective study based on a standardized method

A prospective and consecutive series of 72 patients with rectal carcinoma was subjected to excision of the rectum. The operations were performed according to a standardized program based on previous studies and established surgical principles:

1. Two days on a liquid diet, laxative, and enemas.
2. Irrigation of the pelvic cavity with 5 liters of saline solution after removal of the specimen.
3. Leaving the pelvic peritoneum unsutured.
4. Obliteration of the presacral cavity with living omentum, uterus, or small intestine.
5. Suprapubic, closed suction drainage.
6. Primary closure of abdominal and perineal wounds without drainage.
7. Antibiotic prophylaxis against aerobic as well as anaerobic bacteria.
8. Parenteral nutrition from the first postoperative day and until the bowel acts properly.

Two patients died postoperatively (3%), and 93% achieved primary healing of the perineal wound.     

Biocompatible heterogeneous porous gel matrix NeuroGelTM promotes regeneration of rat sciatic nerve within tubular silicone prosthesis (experimental study)

Background

The purpose of this study was to investigate the ability of NeuroGel? to promote and enhance the regeneration of rat sciatic nerve within a 10-mm gap using silicone tubular prosthesis, and to evaluate and compare the regeneration outcomes versus autologous grafting.

Methods

The 10-mm gap of rat sciatic nerve was bridged through silicone tubular prosthesis filled with dehydrated NeuroGel?, and NeuroGel? saturated with rat NGF-B (NG30-NGG60, NGgfB30-NGgfB60). To assess the regeneration of the peripheral nerve we utilized three general and most commonly applied methods: electrophysiologic, hystomorphometric, and functional methods.

Results

The average M-wave amplitude (A_MW index), or the intermediary index of the number of regenerated axons, in animal groups NGG60 and NGgfB60 60 days post-op was: 2.44?±?0.57 mV and 1.87?±?0.48 mV. These indices were statistically lower compared to the indices obtained after autologous grafting. The average impulse conduction velocity along motor fibers (V_MF index), or the intermediary index of myelination rate, was: 13.3 mm/ms and 13.3 mm/ms, respectively, statistically equal to indices obtained after autologous grafting. The average density (D) of regenerated fibers (direct numerical indicator in contrast to intermediary A_MW index) in animal groups NGG60 and NGgfB60 was: 4,920?±?178.88 and 5,340?±?150.33 per mm², respectively. These indices were statistically higher versus indices obtained after autologous grafting. Myelination rates of regenerated fibers in animal groups NGG60 and NGgfB60 were 73 and 86 %, respectively. They were also statistically higher. The average sciatic functional index (SFI) in NGG60 and NGgfB60 was: ?25.57?±?3.05 and ?24.124?±?4.8, respectively, which is statistically equal to indices obtained after autologous grafting.

Conclusions

Neurogel? strongly promotes the regeneration of rat sciatic nerve within silicone tubular prosthesis. After bridging a 10-mm gap through silicone prosthesis with Neurogel? or Neurogel? +NGF-B-modified intraluminal space, the myelination rate of regenerated axons of rat sciatic nerve appeared to be higher, and the axon count and functional recovery is similar to results seen with the autografting technique.     

Deferoxamin-konjugierte Hydroxyethylstärkelösung verringert den Reperfusionsschaden der Leber nach hämorrhagischem Schock

Deferoxamine is known to reduce the iron-dependent generation of toxic oxygen- derived radicals during reperfusion of ischaemic tissue. The present study investigates the antioxidative properties of a deferoxamin-conjugated hydroxyethyl starch solution and its effects on the hepatic microcirculation in a haemorrhagic-shock rat model. Methods: Anaesthetized Sprague-Dawley rats were tracheotomized, prepared for invasive haemodynamic monitoring, and subject to haemorrhagic shock (MAP=40?mmHg during 60?min). The animals were resuscitated blood-free with lactated Ringer’s (RILA, n=10), gelatine (GELA, n=10), hydroxyethyl starch (HES, n=10), or deferoxamine-conjugated HES (DFO, n=8) solution (MAP≥70?mmHg). After 1?h of resuscitation the hepatic microcirculation was investigated by intravital microsscopy, the glutathione concentration was measured in liver homogenate, and the thiobarbituric acid reactive substances (TBARS) were determined as markers of lipid peroxidation. Results: Resuscitation resulted in restoration of MAP to ≥70?mmHg within a short time. The volume required to stabilise the arterial pressure during 1?h of resuscitation was significantly less in the DFO group compared with HES, GELA, and RILA. Significantly higher glutathione levels in liver homogenate as well as decreased TBARS levels were observed in the DFO group. The shock-induced increase of leukocyte adhesion in liver sinusoids was significantly attenuated by DFO. Conclusion: DFO significantly attenuates shock-induced oxidative stress, thereby reducing the early inflammatory reaction and improving the hepatic microcirculation.     

Die Versorgung epiphrenischer Ösophagusdivertikel in laparoskopisch-transhiataler Technik

Introduction. The operative treatment for epiphenic diverticula is usually performed via thoracotomy or laparotomy. Patients and methods. Alternatively we describe the feasibility of a laparoscopic transhiatal approach in three consecutive symptomatic patients with four epiphrenic diverticula. In all cases, the diverticula were completely resected laparoscopically in combination with an esophagomyotomy and a posterior partial fundoplication. Results. The three patients showed uneventful postoperative courses with a speedy recovery and are symptom-free after a follow-up of 22–41 months. Conclusion. Our results demonstrate that laparoscopic transhiatal procedure in patients with symptomatic epiphrenic diverticula can be performed safely, effectively, and gently.     

Non-cirrhotic portal-systemic encephalopathy caused by enlargement of a splenorenal shunt after pancreaticoduodenectomy for locally advanced duodenal cancer: report of a case

We report a case of portal-systemic encephalopathy occurring secondary to a splenorenal shunt, 2 years after a pancreaticoduodenectomy for locally advanced duodenal carcinoma. A 55-year-old woman was brought to our hospital with a decreased level of consciousness. Laboratory testing revealed an elevated serum ammonia level (221 μg/dl) and normal liver function. Retrospective review of a series of contrast-enhanced computed tomography scans of the abdomen identified a splenorenal shunt, which had gradually enlarged over the past 2 years (Fig. 1). The decreased level of consciousness was thought to be due to portal-systemic encephalopathy secondary to the splenorenal shunt. We performed balloon-occluded retrograde transvenous obliteration to occlude the splenorenal shunt, following which her serum ammonia level returned to normal (28 μg/dl) and an alert level of consciousness was maintained.

Mattress anastomosis in micro vascular reconstruction: technical note

Background

Superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis is a common procedure for neurosurgeons. The surgery necessarily requires accurate and speedy manipulation of microscope, for which a specific training is needed. Unexpected bypass occlusion sometimes happen during surgery.

Objective

Generally, conventional interrupted or continuous suture has been used for vascular anastomosis, despite various ideas have been attempted in the other surgery fields. We propose a horizontal mattress suture technique for intracranial microvascular bypass surgery. This is the first report ever published on intracranial vascular anastomosis.

Methods

We had four patients of STA-MCA bypass surgery with “mattress anastomosis” from March to May of 2012.

Results

During the procedure, there was no bypass occlusion and good patency was confirmed in all cases.

Conclusion

Intimae of the recipient and the donor blood vessel contact each other precisely with this technique. Although a long-term assessment of patency is needed, it is useful for the intracranial bypass surgery.     

Der dorsolaterale Fibularisbypass – Beschreibung des Zugangswegs und erste klinische Erfahrungen

Introduction. Bypass grafting to the peroneal artery (PA) is supposed to be technical demanding. A modified approach to the peroneal artery can simplify this operative procedure. Method. Preparation of the PA is performed by a lateral incision along the margo posterior of the fibula. Without dissection of musculature direct preparation of the PA with it's corresponding veins behind the fibula is possible. Results. This technique was first performed in a patient, when a large tibial ulcer prohibeted a standard medial approach. Since this introduction, the procedure with femoro-peroneal bypass grafting was performed three other times. In no case technical and perioperative complications were observed, all grafts are still patent. Conclusion. The dorsolateral approach to the PA appears as an elegant alternative to the conventional techniques. Besides a distinct reduction of operative trauma it allows a reduction of preparaion time. Additionally, a reduction of approach-dependent complications can be presumed.     

What is new in Sweden? Changing pattern of general surgery

The results of recent studies on the development of general and vascular surgery in Sweden have been analyzed. Among the findings were the following:

1. There was a marked decrease in the number of cholecystectomies performed. Related findings seem to indicate a decline in the incidence of gallstone disease.
2. A slight but continuous decrease in the number of appendectomies performed has occurred over the last decade.
3. There was a decrease in the number of gastric resections performed for gastroduodenal ulcer since 1970 and a considerable total decrease in the number of surgical interventions for this disease since 1977.
4. Arterial reconstructive surgery has increased considerably during the last decade.

The decline in the number of surgical procedures being performed concomitant with an increase in the number of surgeons may have significant impact on departments of surgery throughout Sweden in the near future.     

The effect of topical scar treatment on postoperative scar pain and pruritus after total knee arthroplasty

Introduction

The surgical wound of total knee arthroplasty (TKA) needs continuous flexion and extension movement. Silicone gel treatment is widely used to treat hypertrophic scars and keloids since it is easily applied and prevents scar pain and itching. The aim of this study was to evaluate the clinical efficacy and safety of silicone gel applied to surgical scars of TKA on postoperative scar pain and pruritus.

Materials and methods

One hundred TKAs were randomized into a silicone gel group (silicone gel was applied to the wound after stitch-out for 1 month) or a placebo group. The postoperative scar pain and pruritus were evaluated with the use of a visual analog scale (VAS) at postoperative 3 months, 6 months and 1 year. Scar assessment was done using the Vancouver scar scale by evaluating scar pigmentation, vascularity, pliability, and height.

Results

Although silicone gel group showed better pigmentation and height scales than placebo group (P < 0.05), there were no significant differences in the postoperative scar pain and pruritus VAS scores between the groups (P > 0.05).

Conclusions

Application of silicone gel had no beneficial effects on scar pain and itching relief during the early postoperative period of TKA.

Level of evidence

I-Randomized Controlled Trial     

Die so genannte Box-Osteotomie – eine neue Technik der proximalen Umstellungsosteotomie bei Gonarthrose

Objective Stable correction of a varus knee with osteoarthritis of the medial and patellofemoral compartments through a high tibial valgization osteotomy. Indications Painful osteoarthritis of the medial compartment with or without patellofemoral involvement in patients with varus knee. Contraindications Osteoarthritis of the lateral compartment. Varus exceeding 15° and flexion deformity exceeding 10°. Severe limitation of movement. Instability of knee. Uncooperative patient. Sugical Technique Transverse lateral approach. Resectio of proximal tibiofibular joint. Lateral wedge resection osteotomy, leaving an anterior bony ledge at the distal and a posterior ledge at the proximal fragment (box osteotomy). Anterior translation of distal fragment. Fixation with stepped staple. Cylinder cast for 6 weeks. Results Report on 16 patients (nine women, seven men, age 48–64 years) with a minimum follow-up of 30 months (maximum 6 years). Using the Hospital for Special Surgery (HSS) knee score, 93.75 of the patients had either an exellent or good result. The outcome was fair in one patient only. A longitudinal assessment using the HSS score showed a reduction in the mean score over the period of reporting.     

No evidence for superiority of air or oxygen for neonatal resuscitation: a meta-analysis

Purpose

The aim of this meta-analysis was to re-evaluate the evidence in favour of oxygen or room air as the initial gas mixture for neonatal resuscitation in terms of the following outcomes: death, hypoxic/ischemic encephalopathy, need for tracheal intubation, and APGAR score??Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration??at five minutes.

Methods

A search with no language restriction for all available controlled clinical trials (CCT) was conducted in PUBMED, Cochrane Central Register of Controlled Trials, and EMBASE. Data were extracted independently by the two investigators.

Results

Eight CCTs were retained for analysis. They included 1,500 patients, 772 in the oxygen group and 728 in the air group. The evidence is based mainly on quasi-randomized studies (1,311/1,500) with unblinded resuscitators (1,421/1,500). The expertise/training of the resuscitators was unspecified for four of the eight studies. The risk ratio (RR) for death was 1.35 (95% confidence intervals [CI]?=?0.97 to 1.88; P?=?0.08; I-squared 0%). The RR for hypoxic/ischemic encephalopathy was 1.03 (95% CI?=?0.86 to 1.23; P?=?0.74; I-squared 0%). The RR for requiring a tracheal intubation was 0.85 (95% CI?=?0.69 to 1.05 [random effects model]; P?=?0.12; I-squared?=?9.51%).

Conclusions

The literature is insufficient to make any statement regarding the superiority of oxygen or room air as the initial gas mixture for neonatal resuscitation.