Effects of Oxygenation Targets on Mortality in Critically Ill Patients in Intensive Care Units: A Systematic Review and Meta-Analysis.

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Anesthesia and analgesia Pub Date : 2024-10-01 Epub Date: 2024-09-04 DOI:10.1213/ANE.0000000000006859
Lei Cao, Qi Chen, Ying-Ying Xiang, Cheng Xiao, Yu-Ting Tan, Hong Li
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引用次数: 0

Abstract

Background: The effects of oxygenation targets (partial pressure of arterial oxygen [Pa o2 ], arterial oxygen saturation [Sa o2 ]/peripheral oxygen saturation [Sp o2 ], or inspiratory oxygen concentration [Fi o2 ] on clinical outcomes in critically ill patients remains controversial. We reviewed the existing literature to assess the effects of lower and higher oxygenation targets on the mortality rates of critically ill intensive care unit (ICU) patients.

Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched from their dates of inception to December 31, 2022, for randomized controlled trials (RCTs) comparing lower and higher oxygenation targets for critically ill patients ≥18 years of age undergoing mechanical ventilation, nasal cannula, oxygen mask, or high-flow oxygen therapy in the ICU. Data extraction was conducted independently, and RoB 2.0 software was used to evaluate the quality of each RCT. A random-effects model was used for the meta-analysis to calculate the relative risk (RR). We used the I 2 statistic as a measure of statistical heterogeneity. Certainty of evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.

Results: We included 12 studies with a total of 7416 patients participating in RCTs. Oxygenation targets were extremely heterogeneous between studies. The meta-analysis found no differences in mortality between lower and higher oxygenation targets for critically ill ICU patients (relative risk [RR], 1.00; 95% confidence interval [CI], 0.93-1.09; moderate certainty). The incidence of serious adverse events (RR, 0.93; 95% CI, 0.85-1.00; high certainty), mechanical ventilation-free days through day 28 (mean difference [MD], -0.05; 95%CI, -1.23 to 1.13; low certainty), the number of patients requiring renal replacement therapy (RRT) (RR, 0.96; 95% CI, 0.84-1.10; low certainty), and ICU length of stay (MD, 1.05; 95% CI, -0.04 to 2.13; very low certainty) also did not differ among patients with lower or higher oxygenation targets.

Conclusions: Critically ill ICU patients ≥18 years of age managed with lower and higher oxygenation targets did not differ in terms of mortality, RRT need, mechanical ventilation-free days through day 28, or ICU length of stay. However, due to considerable heterogeneity between specific targets in individual studies, no conclusion can be drawn regarding the effect of oxygenation targets on ICU outcomes.

吸氧目标对重症监护病房重症患者死亡率的影响:系统回顾与元分析》。
背景:氧合目标(动脉血氧分压[Pao2]、动脉血氧饱和度[Sao2]/外周血氧饱和度[Spo2]或吸入氧浓度[Fio2])对重症患者临床预后的影响仍存在争议。我们回顾了现有文献,以评估较低和较高氧合目标对重症监护病房(ICU)重症患者死亡率的影响:方法:检索了 MEDLINE、EMBASE、Cochrane 对照试验中央登记册和 Web of Science 数据库中从开始日期到 2022 年 12 月 31 日的随机对照试验 (RCT),比较了在重症监护室接受机械通气、鼻导管、氧气面罩或高流量氧疗的年龄≥18 岁的重症患者的较低和较高氧合目标。数据提取工作独立进行,并使用 RoB 2.0 软件评估每项 RCT 的质量。荟萃分析采用随机效应模型计算相对风险(RR)。我们使用 I2 统计量来衡量统计异质性。证据的确定性根据建议评估、发展和评价分级(GRADE)指南进行评估:我们纳入了 12 项研究,共有 7416 名患者参与了 RCT 研究。不同研究的吸氧目标差异极大。荟萃分析发现,ICU 重症患者的死亡率在较低和较高氧合目标之间没有差异(相对风险 [RR],1.00;95% 置信区间 [CI],0.93-1.09;中等确定性)。严重不良事件发生率(RR,0.93;95% CI,0.85-1.00;高度确定性)、第 28 天无机械通气天数(平均差 [MD],-0.05;95%CI,-1.23 至 1.13;低度确定性)、需要肾脏替代疗法(RRT)的患者人数(RR,0.96;95% CI,0.84-1.10;低确定性)、ICU住院时间(MD,1.05;95% CI,-0.04-2.13;极低确定性)在氧合目标较低或较高的患者中也没有差异:结论:在死亡率、RRT需求、第28天无机械通气天数或重症监护室住院时间方面,使用较低和较高氧合目标的≥18岁重症监护室患者没有差异。然而,由于个别研究的具体目标之间存在很大的异质性,因此无法就氧合目标对 ICU 结果的影响得出结论。
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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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