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Critical Care

, 18:711

First Online: 23 December 2014Received: 11 September 2014Accepted: 08 December 2014

Abstract

IntroductionThe safety of arterial hyperoxia is under increasing scrutiny. We performed a systematic review of the literature to determine whether any association exists between arterial hyperoxia and mortality in critically ill patient subsets.

MethodsMedline, Thomson Reuters Web of Science and Scopus databases were searched from inception to June 2014. Observational or interventional studies evaluating the relationship between hyperoxia defined as a supranormal arterial O2 tension and mortality in adult intensive care unit ICU patients were included. Studies primarily involving patients with exacerbations of chronic pulmonary disease, acute lung injury and perioperative administration were excluded. Adjusted odds ratio OR of patients exposed versus those not exposed to hyperoxia were extracted, if available. Alternatively, unadjusted outcome data were recorded. Data on patients, study characteristics and the criteria used for defining hyperoxia exposure were also extracted. Random-effects models were used for quantitative synthesis of the data, with a primary outcome of hospital mortality.

ResultsIn total 17 studies 16 observational, 1 prospective before-after were identified in different patient categories: mechanically ventilated ICU number of studies k = 4, number of participants n = 189,143, post-cardiac arrest k = 6, n = 19,144, stroke k = 2, n = 5,537, and traumatic brain injury k = 5, n = 7,488. Different criteria were used to define hyperoxia in terms of PaO2 value first, highest, worst, mean, time of assessment and predetermined cutoffs. Data from studies on ICU patients were not pooled because of extreme heterogeneity inconsistency I 96.73%. Hyperoxia was associated with increased mortality in post-cardiac arrest patients OR = 1.42 1.04 to 1.92 I 67.73% stroke OR = 1.23 1.06 to 1.43 I 0% and traumatic brain injury OR = 1.41 1.03 to 1.94 I 64.54%. However, these results are limited by significant heterogeneity between studies.

ConclusionsHyperoxia may be associated with increased mortality in patients with stroke, traumatic brain injury and those resuscitated from cardiac arrest. However, these results are limited by the high heterogeneity of the included studies.

AbbreviationsA-aalveolar-arterial

ABGarterial blood gas

ALIacute lung injury

APACHEAcute Physiology and Chronic Health Evaluation

CIconfidence interval

COPDchronic obstructive pulmonary disease

ESeffect size

FiO2inspired oxygen fraction

Iinconsistency analysis

ICUintensive care unit

ISSInjury Severity Score

knumber of studies

nnumber of participants

NOSNewcastle-Ottawa Scale

O2oxygen

ORodds ratio

PaO2arterial partial oxygen pressure

RCTrandomized controlled trial

SAPSSimplified Acute Physiology Score

SOFASequential Organ Failure Assessment

SpO2peripheral oxygen saturation

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0711-x contains supplementary material, which is available to authorized users.

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Author: Elisa Damiani - Erica Adrario - Massimo Girardis - Rocco Romano - Paolo Pelaia - Mervyn Singer - Abele Donati

Source: https://link.springer.com/







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