Higher vs Lower Oxygenation Strategies in Acutely Ill Adults: A Systematic Review With Meta-Analysis and Trial Sequential Analysis.

Acute Disease / mortality Adult Humans Oxygen Inhalation Therapy / adverse effects
critical care meta-analysis mortality oxygen systematic review

Journal

Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335

Informations de publication

Date de publication:
01 2021
Historique:
received: 30 01 2020
revised: 30 06 2020
accepted: 12 07 2020
pubmed: 21 7 2020
medline: 12 6 2021
entrez: 21 7 2020
Statut: ppublish

Résumé

Liberal oxygen supplementation is often used in acute illness but has, in some studies, been associated with harm. The goal of this study was to assess the benefits and harms of higher vs lower oxygenation strategies in acutely ill adults. This study was an updated systematic review with meta-analysis and Trial Sequential Analysis (TSA) of randomized clinical trials. A clear differentiation (separation) was made between a higher (liberal) oxygenation and a lower (conservative) oxygenation strategy and their effects on all-cause mortality, serious adverse events, quality of life, lung injury, sepsis, and cardiovascular events at time points closest to 90 days in acutely ill adults. The study included 50 randomized clinical trials of 21,014 participants; 36 trials with a total of 20,166 participants contributed data to the analyses. Meta-analysis and TSAs showed no difference between higher and lower oxygenation strategies in trials at overall low risk of bias except for blinding: mortality relative risk (RR), 0.98 (95% CI, 0.89-1.09; TSA-adjusted CI, 0.86-1.12; low certainty evidence); serious adverse events RR, 0.99 (95% CI, 0.89-1.12; TSA-adjusted CI, 0.83-1.19; low certainty evidence). The corresponding summary estimates including trials with overall low and high risk of bias showed similar results. No difference was found between higher and lower oxygenation strategies in meta-analyses and TSAs regarding quality of life, lung injury, sepsis, and cardiovascular events (very low certainty evidence). No evidence was found of beneficial or harmful effects of higher vs lower oxygenation strategies in acutely ill adults (low to very low certainty evidence). PROSPERO; No.: CRD42017058011; URL: https://www.crd.york.ac.uk/prospero/.

Sections du résumé

BACKGROUND
Liberal oxygen supplementation is often used in acute illness but has, in some studies, been associated with harm.
RESEARCH QUESTION
The goal of this study was to assess the benefits and harms of higher vs lower oxygenation strategies in acutely ill adults.
STUDY DESIGN AND METHODS
This study was an updated systematic review with meta-analysis and Trial Sequential Analysis (TSA) of randomized clinical trials. A clear differentiation (separation) was made between a higher (liberal) oxygenation and a lower (conservative) oxygenation strategy and their effects on all-cause mortality, serious adverse events, quality of life, lung injury, sepsis, and cardiovascular events at time points closest to 90 days in acutely ill adults.
RESULTS
The study included 50 randomized clinical trials of 21,014 participants; 36 trials with a total of 20,166 participants contributed data to the analyses. Meta-analysis and TSAs showed no difference between higher and lower oxygenation strategies in trials at overall low risk of bias except for blinding: mortality relative risk (RR), 0.98 (95% CI, 0.89-1.09; TSA-adjusted CI, 0.86-1.12; low certainty evidence); serious adverse events RR, 0.99 (95% CI, 0.89-1.12; TSA-adjusted CI, 0.83-1.19; low certainty evidence). The corresponding summary estimates including trials with overall low and high risk of bias showed similar results. No difference was found between higher and lower oxygenation strategies in meta-analyses and TSAs regarding quality of life, lung injury, sepsis, and cardiovascular events (very low certainty evidence).
INTERPRETATION
No evidence was found of beneficial or harmful effects of higher vs lower oxygenation strategies in acutely ill adults (low to very low certainty evidence).
CLINICAL TRIAL REGISTRATION
PROSPERO; No.: CRD42017058011; URL: https://www.crd.york.ac.uk/prospero/.

Identifiants

DOI: 10.1016/j.chest.2020.07.015 PMID: 32687907
pubmed: 32687907
pii: S0012-3692(20)31912-7
doi: 10.1016/j.chest.2020.07.015
pii:
doi:

Types de publication

Journal Article Meta-Analysis Research Support, Non-U.S. Gov't Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

154-173

Informations de copyright

Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Auteurs

Marija Barbateskovic (M)

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Denmark; Centre for Research in Intensive Care, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: marija.barbateskovic@ctu.dk.

Olav L Schjørring (OL)

Centre for Research in Intensive Care, Rigshospitalet, University of Copenhagen, Denmark; Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Denmark; Department of Anaesthesia and Intensive Care, Aalborg University, Aalborg, Denmark.

Sara Russo Krauss (SR)

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Denmark.

Christian S Meyhoff (CS)

Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Denmark.

Janus C Jakobsen (JC)

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Regional Health Research, the Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Cardiology, Holbaek Hospital, Holbaek, Denmark.

Bodil S Rasmussen (BS)

Centre for Research in Intensive Care, Rigshospitalet, University of Copenhagen, Denmark; Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Denmark; Department of Anaesthesia and Intensive Care, Aalborg University, Aalborg, Denmark.

Anders Perner (A)

Centre for Research in Intensive Care, Rigshospitalet, University of Copenhagen, Denmark; Department of Intensive Care, Rigshospitalet, University of Copenhagen, Denmark.

Jørn Wetterslev (J)

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Denmark; Centre for Research in Intensive Care, Rigshospitalet, University of Copenhagen, Denmark.

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Classifications MeSH

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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Higher vs Lower Oxygenation Strategies in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Higher vs Lower Oxygenation Strategies in...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Oxygénothérapie › Higher vs Lower Oxygenation Strategies in...