Low vs. High FiO2

• High FiO2 is pro-inflammatory (pro-cancer?), generates ROS, drives resorption atelectasis, worsens HPV, may not prevent SSI.
• High FiO2 undeniably buys apnea time
• Extubation practices vary, but one common practice is to remove PEEP, and turn FiO2 to 100%.
• This practice is associated with worsened post-extubation atelectasis and end-expiratory lung volumes (EELV) according to a 2026 BJA paper from a team at BIDMC who used EIT to measure atelectasis and lung volumes. Conversely, using an FiO2 of 40% or 70% was shown to decrease atelectasis and increase EELV.

https://journals.lww.com/anesthesia-analgesia/fulltext/10.1213/ane.0000000000004374~when-less-is-more-why-extubation-with-less-than-routine-100

https://journals.lww.com/anesthesiology/fulltext/10.1097/aln.0000000000004654~extubation-with-reduced-inspiratory-oxygen-concentration-or