biostudies-literaturePENGUIN Trial Management Groupj.glasbey@bham.ac.uk23cgeorge@gmail.comNational Institute for Health Research (NIHR)National Institute for Health and Care Research100396https://www.ebi.ac.uk/biostudies/studies/S-EPMC12008669biostudies-literatureUnknown14<h4>Background</h4>Infections are a common complication of abdominal surgery in low- and middle-income countries (LMICs). The role of a high fraction of inspired oxygen (FiO₂) and chlorhexidine mouthwash in preventing post-operative infections is unconfirmed.<h4>Methods</h4>Internal pilot phase of an international outcome assessor-blinded, 2x2 factorial randomised trial of patients aged ≥10-years undergoing midline laparotomy in LMIC hospitals. The main trial objectives are to compare the clinical effectiveness of preoperative 0.2% chlorhexidine mouthwash in preventing pneumonia versus no mouthwash, and 80-100% perioperative FiO₂ to prevent surgical site infection (SSI) versus 21-35% FiO₂. This 12-month internal pilot assessed feasibility of hospital site oBJA openPErioperative respiratory care aNd outcomes for patients underGoing hIgh risk abdomiNal surgery (PENGUIN): a randomised international internal pilot trial.PMC12008669NIHR30017516.136.79Gumede SWBalija SSHaque PDLillywhite RGarry GKMahajan AKadir BShajahan SMartin JCrawford RDhamija PKapoor DGoswami JSeenivasagam RKPatro VHans PJain DRathod KKRajappa RWilson GSPearse RSingh SKSoden MGeorge CDesai NBoutall ABMathai SPENGUIN Trial Management GroupBannister SJJhanji SNIHR Global Health Research Unit on Global Surgery CollaboratorsPENGUIN Trial Management Groupj.glasbey@bham.ac.uk23cgeorge@gmail.comGhosh DThind RSGoyal AVishnoi JRTabiri SMorton DDhiman JChakrabortee SKaur HLawani ILaurberg SCousens SBhangu ASuroy ARayamajhi SRoberts TMichael VRunigamugabo EChaudhary RKothari NBiccard BDaniel SJoshva MKumar PHaque PGhosh DNGoyal SDaniel NRodha MSPoonia DRSentholang NGlasbey JSharma NTripathi DKSharma SSanchez IDSmart NHudda FMisra SRajkumar AWinkles NAggarwal MPareek PBhatt AHardy PVarshney VKJakhar RChandra Soni SChowdhury SBhatia PKVazquez DGSchultz MKachapila MTalwar POmar OSmith DPerez Maldonado LMBiccard BMMoore RLara MMAdemuyiwa AFlint MGMagill LLeslie KRamos-De la Medina ABrown JKumar KFourtounas MKumar AYu LMfalsePErioperative respiratory care aNd outcomes for patients underGoing hIgh risk abdomiNal surgery (PENGUIN): a randomised international internal pilot trial.<h4>Background</h4>Infections are a common complication of abdominal surgery in low- and middle-income countries (LMICs). The role of a high fraction of inspired oxygen (FiO₂) and chlorhexidine mouthwash in preventing post-operative infections is unconfirmed.<h4>Methods</h4>Internal pilot phase of an international outcome assessor-blinded, 2x2 factorial randomised trial of patients aged ≥10-years undergoing midline laparotomy in LMIC hospitals. The main trial objectives are to compare the clinical effectiveness of preoperative 0.2% chlorhexidine mouthwash in preventing pneumonia versus no mouthwash, and 80-100% perioperative FiO₂ to prevent surgical site infection (SSI) versus 21-35% FiO₂. This 12-month internal pilot assessed feasibility of hospital site o2025-01-01T00:00:00Z2025 Jun2026-05-02T14:20:49.771Z2025-07-03T03:05:05.186ZS-EPMC120086694025564610.1016/j.bjao.2025.100396