Effects of Oxygenation Targets on Mortality in Critically Ill Patients in Intensive Care Units

BACKGROUND:

The effects of oxygenation targets (partial pressure of arterial oxygen [Pao₂], arterial oxygen saturation [Sao₂]/peripheral oxygen saturation [Spo₂], or inspiratory oxygen concentration [Fio₂] 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 I² 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.