Higher versus lower oxygenation strategies in the general intensive care unit population: A systematic review, meta-analysis and meta-regression of randomized controlled trials

ElsevierVolume 72, December 2022, 154151Journal of Critical CareHighlights•

In the general ICU population, a lower incidence of serious adverse events was found for lower oxygenation strategies.

There was no difference in 90-day mortality between higher and lower oxygenation strategies.

It remains important to conduct trials, comparing groups with a clinically relevant contrast and focusing on side effects.

AbstractPurpose

Oxygen therapy is vital in adult intensive care unit (ICU) patients, but it is indistinct whether higher or lower oxygen targets are favorable. Our aim was to update the findings of randomized controlled trials (RTCs) comparing higher and lower oxygen strategies.

Materials and methods

MEDLINE, EMBASE, and Web of Science were searched. RCTs comparing higher (liberal, hyperoxia) and lower (conservative, normoxia) oxygen in adult mechanically ventilated ICU patients were included. The main outcome was 90-day mortality; other outcomes include serious adverse events (SAE), support free days and length of stay (LOS).

Results

No significant difference was observed for 90-day mortality. A lower incidence was found for SAEs, favoring lower oxygenation (OR, 0.86; 95%CI, 0.77–0.96; I 2 13%). No differences were observed in either support free days at day 28 or ICU and hospital LOS.

Conclusions

No difference was found for 90-day mortality, support free days and ICU and hospital LOS. However, a lower incidence of SAEs was found for lower oxygenation. These findings may have clinical implications for practice guidelines, yet it remains of paramount importance to continue conducting clinical trials, comparing groups with a clinically relevant contrast and focusing on the impact of important side effects.

Keywords

Oxygen

Intensive care medicine

Hyperoxia

Hypoxia

Mechanical ventilation

Serious adverse events

AbbreviationsGRADE

Grading of Recommendation, Assessment, Development and Evaluation

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

RCT

Randomized Controlled Trial

SAE

Serious Adverse Events

© 2022 The Authors. Published by Elsevier Inc.

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