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Both 40% and 80% fraction of inspired oxygen (FiO\n                      <jats:sub>2<\/jats:sub>\n                      ) are commonly used for anesthesia. Presently, whether 40% FiO\n                      <jats:sub>2<\/jats:sub>\n                      can increase the oxygenation index of patients 48\u00a0h postoperatively and reduce PPCs remains controversial. Moreover, no clear consensus exists for older adult patients. Therefore, this study aims to compare the effects of low FiO\n                      <jats:sub>2<\/jats:sub>\n                      (40%) and high FiO\n                      <jats:sub>2<\/jats:sub>\n                      (80%) levels on postoperative pulmonary function in older adult study participants undergoing laparoscopic gastrointestinal surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This multicenter, prospective, parallel-cohort, randomized controlled clinical trial will include 1098 older adult participants aged\u2009\u2265\u200965 years old undergoing laparoscopic gastrointestinal surgery, from 16 clinical trial sites across China. Participants will be randomized, as per a 1:1 ratio to two cohorts, the \u201cL\u201d and \u201cH\u201d cohorts, to receive low FiO\n                      <jats:sub>2<\/jats:sub>\n                      (40%) and high FiO\n                      <jats:sub>2<\/jats:sub>\n                      (80%) levels, respectively. The primary outcome measure is the 48-h postoperative oxygenation index between the two cohorts. The secondary outcome measures include the other blood gas analysis results, PPCs within 7\u00a0days, and 30-day mortality rate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study of elderly patients undergoing laparoscopic gastrointestinal surgery with different intraoperative oxygen concentrations at high risk for pulmonary complications. All subjects were followed up for up to 30\u00a0days for pulmonary function, postoperative complications, etc. Randomization was performed separately at 16 sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT06359106. Registered and posted on April 11, 2024.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13063-026-09471-3","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T03:04:42Z","timestamp":1769137482000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of varying inhaled oxygen concentrations on lung function in older adult patients undergoing laparoscopic gastrointestinal surgery under general anesthesia: protocol of a prospective multicenter clinical study in China"],"prefix":"10.1186","volume":"27","author":[{"given":"Tianhao","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"An","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiling","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lining","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianbo","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Lei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianlin","family":"Shao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Luan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiannan","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeqing","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaoran","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongshan","family":"Nan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bing","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xijia","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenfei","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"9471_CR1","unstructured":"World Health Organization.Global guidelines for the prevention of surgical site infection. 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Br J Anaesth. 2017;119(1):140\u20139. https:\/\/doi.org\/10.1093\/bja\/aex128.","journal-title":"Br J Anaesth"}],"container-title":["Trials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13063-026-09471-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13063-026-09471-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13063-026-09471-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T10:57:43Z","timestamp":1771325863000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13063-026-09471-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["9471"],"URL":"https:\/\/doi.org\/10.1186\/s13063-026-09471-3","relation":{},"ISSN":["1745-6215"],"issn-type":[{"value":"1745-6215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"assertion":[{"value":"31 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study has been approved by the Ethics Committee (EC) of The First Hospital of China Medical University on the 03\/01\/2024, with the EC approval number 2024-263. Moreover, this study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Written informed consent will be obtained from all study participants for their participation in the study and publication of their de-identified data. In cases where the participant is unable to do so, a legally authorized representative or caregiver will be contacted to provide consent on behalf of the participant, in accordance with the GCP guidelines. The trial protocol has been also approved by the Ethics Committee of Dalian Third People\u2019s Hospital (approval number: 2024-046-002), Harbin Medical University Cancer Hospital (approval number: 2024-182-R), The Second Hospital of Hebei Medical University (approval number: 2024-C023-F1), The First Hospital of Hebei Medical University (approval number: 2024-080), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital (approval number: YXLL-KY-2024(053)), Sichuan Provincial People\u2019s Hospital (approval number: 2024-221), The First Affiliated Hospital of Harbin Medical University (approval number: 0202494), The First Affiliated Hospital of Kunming Medical University (approval number: 2024-L-97), Beijing Friendship Hospital, Capital Medical University (approval number: BFHHZMP20240008), The First Affiliated Hospital of Dalian Medical University (approval number: PJ-KS-KY-2024-505(X)), The Affiliated Hospital of Qingdao University (approval number: QYFYEC2024-44-01), Chifeng Municipal Hospital(approval number: CK202474), Liaoning Cancer Hospital & Institute (approval number: KY20240708-2), Shenzhen People\u2019s Hospital (approval number: LL-KY-2024112-02), and Yanbian University Hospital (approval number: 2024273). The findings of the trial will be presented at academic conferences, both nationally and internationally, and published in journals undergoing peer review.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate {24}"}},{"value":"The authors approve the publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication {32}"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests {28}"}}],"article-number":"139"}}