Dept of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
Dept of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China.
Eur Respir J. 2021 Oct 1;58(3). doi: 10.1183/13993003.02928-2020. Print 2021 Sep.
The optimal oxygenation in mechanically ventilated critically ill patients remains unclear.
We performed a systematic review of randomised controlled trials (RCTs) with the aim to classify oxygenation goals and investigate their relative effectiveness. RCTs investigating different oxygenation goal-directed mechanical ventilation in critically ill adult patients were eligible for the analysis. The trinary classification classified oxygenation goals into conservative (partial pressure of arterial oxygen ( ) 55-90 mmHg), moderate ( 90-150 mmHg) and liberal ( >150 mmHg). The quadruple classification further divided the conservative goal from the trinary classification into far-conservative ( 55-70 mmHg) and conservative ( 70-90 mmHg) goals. The primary outcome was 30-day mortality. The secondary outcomes included intensive care unit, hospital and 90-day mortalities. The effectiveness was estimated by the relative risk and 95% credible interval (CrI) using network meta-analysis and visualised using surface under the cumulative ranking curve (SUCRA) scores and survival curves.
We identified eight eligible studies involving 2532 patients. There were no differences between conservative and moderate goals (relative risk 1.08, 95% CrI 0.85-1.36; moderate quality), between moderate and liberal goals (relative risk 0.83, 95% CrI 0.61-1.10; low quality) or between conservative and liberal goals (relative risk 0.89, 95% CrI 0.61-1.30; low quality) based on the trinary classification. There were no differences in secondary outcomes among the different goals. The results were consistent between the trinary and quadruple classifications. The SUCRA scores and survival curves suggested that the moderate goal in the trinary and quadruple classifications and the conservative goal in the quadruple classification may be superior to the liberal and far-conservative goals.
Different oxygenation goals do not lead to different mortalities in mechanically ventilated critically ill patients. The potential superiority of maintaining in the range 70-150 mmHg remains to be validated.
机械通气危重症患者的最佳氧合仍不明确。
我们进行了一项系统综述，纳入了随机对照试验（RCT），旨在对氧合目标进行分类并探讨其相对有效性。符合纳入标准的 RCT 需纳入接受不同氧合目标导向性机械通气的成年危重症患者。氧合目标被分为保守（动脉血氧分压（ ）55-90mmHg）、适度（ 90-150mmHg）和宽松（ >150mmHg）三组。四分类法进一步将保守组分为极保守（ 55-70mmHg）和保守（ 70-90mmHg）。主要结局为 30 天死亡率。次要结局包括 ICU 死亡率、医院死亡率和 90 天死亡率。使用网状荟萃分析评估有效性，并通过累积排序曲线下面积（SUCRA）评分和生存曲线进行可视化。
我们纳入了 8 项研究，共涉及 2532 例患者。保守与适度目标之间（相对风险 1.08，95%可信区间 0.85-1.36；中等质量）、适度与宽松目标之间（相对风险 0.83，95%可信区间 0.61-1.10；低质量）或保守与宽松目标之间（相对风险 0.89，95%可信区间 0.61-1.30；低质量）无差异。不同目标的次要结局无差异。三组和四组分类结果一致。SUCRA 评分和生存曲线提示三组和四组分类中的适度目标以及四组分类中的保守目标可能优于宽松和极保守目标。
不同的氧合目标并未导致机械通气危重症患者死亡率的差异。维持 在 70-150mmHg 范围内可能具有潜在优势，但仍需验证。
