Xiao-Li Chen1, Bei-Lei Zhang1, Chang Meng2, Hui-Bin Huang3, Bin Du4. 1. Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China. 2. Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China. 3. Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China. hhba02922@btch.edu.cn. 4. Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, China.
Abstract
OBJECTIVE: Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies' effect and safety in ICU patients. METHODS: We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. RESULTS: We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97-1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05-1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies. CONCLUSIONS: Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results.
OBJECTIVE: Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies' effect and safety in ICU patients. METHODS: We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically illpatients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. RESULTS: We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97-1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05-1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies. CONCLUSIONS: Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results.
Authors: Dion Stub; Karen Smith; Stephen Bernard; Ziad Nehme; Michael Stephenson; Janet E Bray; Peter Cameron; Bill Barger; Andris H Ellims; Andrew J Taylor; Ian T Meredith; David M Kaye Journal: Circulation Date: 2015-05-22 Impact factor: 29.690
Authors: Eddy Fan; Lorenzo Del Sorbo; Ewan C Goligher; Carol L Hodgson; Laveena Munshi; Allan J Walkey; Neill K J Adhikari; Marcelo B P Amato; Richard Branson; Roy G Brower; Niall D Ferguson; Ognjen Gajic; Luciano Gattinoni; Dean Hess; Jordi Mancebo; Maureen O Meade; Daniel F McAuley; Antonio Pesenti; V Marco Ranieri; Gordon D Rubenfeld; Eileen Rubin; Maureen Seckel; Arthur S Slutsky; Daniel Talmor; B Taylor Thompson; Hannah Wunsch; Elizabeth Uleryk; Jan Brozek; Laurent J Brochard Journal: Am J Respir Crit Care Med Date: 2017-05-01 Impact factor: 21.405
Authors: Diane Mackle; Rinaldo Bellomo; Michael Bailey; Richard Beasley; Adam Deane; Glenn Eastwood; Simon Finfer; Ross Freebairn; Victoria King; Natalie Linke; Edward Litton; Colin McArthur; Shay McGuinness; Rakshit Panwar; Paul Young Journal: N Engl J Med Date: 2019-10-14 Impact factor: 176.079
Authors: Thomas Lass Klitgaard; Olav Lilleholt Schjørring; Frederik Mølgaard Nielsen; Christian Sylvest Meyhoff; Marija Barbateskovic; Jørn Wetterslev; Anders Perner; Bodil Steen Rasmussen Journal: J Intensive Care Date: 2021-12-07