Oxigenoterapia conservadora vs. liberal en pacientes críticos con ventilación mecánica invasiva. Revisión sistemática y metaanálisis

Abstract

Objectives

To evaluate the benefits and risks of conservative versus liberal oxygen therapy in in patients with IMV.

Design

Systematic review with meta-analysis and TSA of RCTs published in MEDLINE/PubMed, Web of Science, SciELO, Embase, Scopus, and the Cochrane Central of Register of Clinical trials, through December 2024. No language restrictions.

Population

Patients admitted to ICU with IMV, older than 18 years.

Intervention

Conservative oxygen therapy: SatO2 88–92% and/or PaO2 between 55–80 mmHg; Liberal oxygen therapy: SatO2 ≥ 94% or PaO2 ≥ 90 mmHg.

Measurements

Overall mortality, in-ICU mortality, at 28 and 90 days, length of stay, ventilator-free days, and complications.

Results

We included 10 RCTs (n = 5254), all of which were classified as low risk of bias, except for one. Meta-analysis and TSA showed no differences between conservative and liberal strategies regarding overall mortality (RR 0.98; 95% CI 0.96–1.01; p = 0.29, I2: 0%), ICU (RR 0.99; 95% CI 0.96–1.02; p = 0.41, I2: 7%), 28-day (RR 0.98; 95% CI 0.95–1.02; p = 0.4, I2: 0%), or 90-day (RR 0.97; 95% CI 0.94–1.01; p = 0.17, I2: 0%). We found no differences regarding hospital and ICU stay, ventilator-free days, or complications. Subgroup and sensitivity analysis did not modify the results.

Conclusion

We found no beneficial or harmful effects when comparing a conservative versus a liberal strategy with respect to all-cause mortality in adult IMV patients. Other clinical outcomes of interest were also comparable between the two groups.