Data_Sheet_1_The Effect of Conservative Oxygen Therapy in Reducing Mortality in Critical Care Patients: A Meta-Analysis and Trial Sequential Analysis.PDF

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].

背景：保守氧疗可同时预防低氧血症与高氧血症，但其对重症监护病房（intensive care unit, ICU）收治患者预后的影响仍存在争议。
方法：检索所有针对ICU收治的成人患者，对比保守氧疗与常规氧疗的对照研究。本研究的主要结局指标为死亡率，次要结局指标包括ICU住院时长（ICU LOS）、住院时长（hospital LOS）、机械通气（mechanical ventilation, MV）小时数、ICU住院期间新发器官功能衰竭以及ICU住院期间新发感染。
结果：最终共纳入9项试验、合计5759例患者进行合并分析。与常规氧疗相比，保守氧疗未降低总死亡率（Z=0.31，P=0.75），也未缩短ICU住院时长（Z=0.17，P=0.86），试验序贯分析结果显示该结论证据确凿；同时保守氧疗也未缩短住院时长（Z=1.98，P=0.05）或降低ICU住院期间新发感染风险（Z=1.45，P=0.15）。但保守氧疗可缩短机械通气时长（Z=5.05，P<0.00001），减少ICU住院期间新发器官功能衰竭（Z=2.15，P=0.03），并降低肾脏替代治疗（renal replacement therapy, RRT）的使用风险（Z=2.18，P=0.03）。
结论：对于重症患者，保守氧疗未降低死亡率，但可缩短机械通气时长、减少新发器官功能衰竭并降低肾脏替代治疗的使用风险。
系统评价注册：标识符[CRD42020171055]。