Conservative oxygen therapy does not improve prognosis of critically ill patients: Study
Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial.
Conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients, reports a recent study published in the Journal of Intensive Care. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results, explained Xiao-Li Chen and colleagues from the Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
The researchers sought to conduct a systematic review and meta-analysis to examine such oxygen strategies' effect and safety in ICU patients.
Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included for the analysis. The authors included seven trials with a total of 5265 patients.
The 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.
The study results showed that 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 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 had significantly lower mortality 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.
As a result, the authors concluded that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. ICU patients with mild to moderate respiratory failure might obtain prognosis benefit from such a strategy without affecting other critical clinical results.
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Chen, XL., Zhang, BL., Meng, C. et al. Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials. j intensive care 9, 47 (2021). https://doi.org/10.1186/s40560-021-00563-7