Abstract
Background: Conservative oxygen therapy can prevent both hypoxemia and hyperoxemia, but the effect on the prognosis of patients admitted to the intensive care unit (ICU) remains controversial.Methods: All controlled studies comparing conservative oxygen therapy and conventional oxygen therapy in adult patients admitted to the ICU were searched. The primary outcome was mortality, and the secondary outcomes were length of ICU stay (ICU LOS), length of hospital stay (hospital LOS), length of mechanical ventilation (MV) hours, new organ failure during ICU stay, and new infections during ICU stay.Results: Nine trials with a total of 5,759 patients were pooled in our final studies. Compared with conventional oxygen therapy, conservative oxygen therapy did not reduce overall mortality (Z = 0.31, p = 0.75) or ICU LOS (Z = 0.17, p = 0.86), with firm evidence from trial sequential analysis, or hospital LOS (Z = 1.98, p = 0.05) or new infections during the ICU stay (Z = 1.45, p = 0.15). However, conservative oxygen therapy was associated with a shorter MV time (Z = 5.05, p < 0.00001), reduction of new organ failure during the ICU stay (Z = 2.15, p = 0.03) and lower risk of renal replacement therapy (RRT) (Z = 2.18, p = 0.03).Conclusion: Conservative oxygen therapy did not reduce mortality but did decrease MV time, new organ failure and risk of RRT in critically ill patients.Systematic Review Registration: identifier [CRD42020171055].
Highlights
Conservative oxygen therapy can prevent both hypoxemia and hyperoxemia, but the effect on the prognosis of patients admitted to the intensive care unit (ICU) remains controversial
Conservative oxygen therapy was associated with a shorter mechanical ventilation (MV) time (Z = 5.05, p < 0.00001), reduction of new organ failure during the ICU stay (Z = 2.15, p = 0.03) and lower risk of renal replacement therapy (RRT) (Z = 2.18, p = 0.03)
Mortality was reported in nine studies (11, 12, 14–20), among which hospital mortality was reported in three studies (11, 14, 15), ICU mortality was reported in four studies (11, 14, 15, 19), 28-day mortality was reported in four studies (14, 17–19), 30-day mortality was reported in one study (15), 90-day mortality was reported in five studies (12, 16, 18–20), and 180-day mortality was reported in one study (15)
Summary
Conservative oxygen therapy can prevent both hypoxemia and hyperoxemia, but the effect on the prognosis of patients admitted to the intensive care unit (ICU) remains controversial. Hypoxemia is life threatening (1, 2) and is related to increasing intensive care unit (ICU) mortality (3). Oxygen administration is a life-saving treatment commonly used in patients admitted to the ICU (4, 5). Oxygen administration in ICUs is recommended by many guidelines, the most suitable oxygenation target remains unknown (6). In the study by Girardis et al, which included 434 patients, conservative oxygen therapy reduced ICU mortality by approximately 19% (p = 0.01) (11). In the study by Mackle et al, conservative oxygenation targets did not show any advantages in ICU mortality over the conventional oxygenation target (35.7 vs 34.5%) (12)
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