Hirase Takashi, Ruff Eric S, Ratnani Iqbal, Surani Salim R
Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, USA.
Plastic Surgery, University of Texas Medical Branch, Galveston, USA.
Cureus. 2019 Sep 15;11(9):e5662. doi: 10.7759/cureus.5662.
There is mixed evidence in the superiority of conservative versus conventional approach to oxygen therapy among patients admitted into the intensive care unit (ICU). The purpose of this study was to determine if conservative versus conventional oxygenation results in a statistically significant difference in outcomes in ICU patients.
A systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria consisted of Level I-IV investigations of conservative versus conventional oxygenation among ICU patients. ICU mortality, 28-day mortality, in-hospital mortality, ICU length-of-stay, hospital length-of-stay, rate of new infections, and rate of new non-respiratory organ failure were compared using two-sample Z-tests using p-value less than 0.05.
Three thousand four hundred thirty-three articles were screened. Four articles were included in the analysis. Three hundred seventy-two patients under the conservative oxygenation arm (Minimum target SpO2: 88-94%) and 370 patients under the conventional oxygenation arm (Minimum target SpO2: 96-97%) were analyzed. ICU mortality (16.7 ± 9.5% vs. 22.7 ± 6.0%; P<0.01), 28-day mortality (34.6 ± 26.4% vs. 41.6 ± 14.6%; P=0.02), and in-hospital mortality (30.2 ± 22.5% vs. 37.7 ± 14.2%; P<0.01) were all significantly lower in the conservative oxygenation arm versus the conventional oxygenation arm, respectively. Rate of new non-respiratory organ failure was also significantly lower in the conservative oxygenation arm (20.0 ± 8.5% vs. 29.7 ± 11.7%; P<0.01).
The authors conclude that conservative oxygenation therapy could result in significantly lower rates of ICU mortality, 28-day mortality, in-hospital mortality, and new-onset non-respiratory organ failure. Further randomized controlled studies that show clinical outcome improvement in multiple parameters may be worthwhile to assess the true efficacy of this practice.
在重症监护病房（ICU）患者中，保守氧疗与传统氧疗的优越性存在混杂的证据。本研究的目的是确定保守氧疗与传统氧疗在ICU患者的预后方面是否存在统计学上的显著差异。
在国际前瞻性系统评价注册库（PROSPERO）上注册了一项系统评价，并按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。纳入标准包括对ICU患者进行保守氧疗与传统氧疗的I-IV级研究。使用p值小于0.05的双样本Z检验比较ICU死亡率、28天死亡率、住院死亡率、ICU住院时间、住院时间、新感染率和新的非呼吸器官衰竭率。
筛选了3433篇文章。4篇文章纳入分析。分析了保守氧疗组（最低目标SpO2：88-94%）的372例患者和传统氧疗组（最低目标SpO2：96-97%）的370例患者。保守氧疗组的ICU死亡率（16.7±9.5%对22.7±6.0%；P<0.01）、28天死亡率（34.6±26.4%对41.6±14.6%；P=0.02）和住院死亡率（30.2±22.5%对37.7±14.2%；P<0.01）均显著低于传统氧疗组。保守氧疗组新的非呼吸器官衰竭率也显著较低（20.0±8.5%对29.7±11.7%；P<0.01）。
作者得出结论，保守氧疗可显著降低ICU死亡率、28天死亡率、住院死亡率和新发非呼吸器官衰竭率。进一步的随机对照研究若能显示多个参数的临床结局改善，可能值得评估这种做法的真正疗效。
