Liberal oxygen supplementation is often used in acute illness but has, in some studies, been associated with harm. We aimed to assess the benefits and harms of higher versus lower oxygenation strategies in acutely ill adults.
We conducted an updated systematic review with meta-analysis and Trial Sequential Analysis (TSA) of randomised clinical trials (RCTs), having a clear differentiation (separation) between a higher (liberal) oxygenation and a lower (conservative) oxygenation strategy, on all-cause mortality, serious adverse events (SAEs), quality of life, lung injury, sepsis, and cardiovascular events, at timepoint closest to three months in acutely ill adults.
We included 50 RCTs 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% confidence interval (CI) 0.89-1.09, TSA-adjusted CI 0.86-1.12 (low certainty evidence); SAEs 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. We did not find a difference 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).
We did not find evidence of beneficial or harmful effects of higher versus lower oxygenation strategies in acutely ill adults (low to very low certainty evidence).
Copyright © 2020. Published by Elsevier Inc.