The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Can Respir J. 2023 Oct 14;2023:7023712. doi: 10.1155/2023/7023712. eCollection 2023.
To compare the effects of conservative oxygen therapy and conventional oxygen therapy on the mortality of critically ill patients in ICU.
Searching for randomized controlled clinical trials (RCT) on the effect of conservative oxygen therapy and conventional oxygen therapy on the mortality of critically ill patients in computer databases, including PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang, with postdate before August 2022. We have two researchers evaluating the quality of the literature included and extracting data as per the inclusion and exclusion criteria and then analyzed it with RevMan 5.4 statistical software. Primary outcome included short-term mortality (28-day mortality or ICU mortality); secondary outcome included 90-day mortality, ICU length of stay, hospital length of stay, incidence of new organ dysfunction in ICU, incidence of new infection in ICU, and incidence of ICUAW.
A total of 5779 subjects were included in 10 articles, including 2886 in the conservative oxygen therapy group and 2893 in the conventional oxygen therapy group. The meta-analysis showed that conservative oxygen therapy had an advantage over conventional oxygen therapy in terms of short-term mortality (=0.03). Subgroup analysis based on different conservative oxygen targets showed that this advantage was statistically significant when the target is set above 90% (RR = 0.76, 95% CI = 0.62∼0.94, =0.01), while there was no significant difference between conservative oxygen therapy and conventional oxygen therapy when the target is set below 90% (RR = 0.95, 95% CI = 0.79∼1.16, =0.63). In addition, in terms of the incidence of new infections in the ICU (=0.03) and the incidence of ICUAW (=0.03), conservative oxygen therapy also had advantages over conventional oxygen therapy, and the difference was statistically significant. But in terms of 90-day mortality (=0.61), ICU length of stay (=0.96), hospital length of stay (=0.47), and incidence of new organ dysfunction in ICU (=0.61), there was no significant difference between conservative oxygen therapy and conventional oxygen therapy.
Compared with conventional oxygen therapy, conservative oxygen therapy can reduce the short-term mortality of severe patients, especially when the conservative oxygen therapy target is set above 90%. And it can also reduce the incidence of ICU new infections and ICUAW, while having no effect on 90-day mortality, ICU length of stay, and hospital length of stay.
比较保守氧疗和常规氧疗对 ICU 危重症患者死亡率的影响。
计算机检索 PubMed、Embase、Cochrane Library、CNKI、VIP、万方等数据库中关于保守氧疗和常规氧疗对 ICU 危重症患者死亡率影响的随机对照临床试验（RCT），检索时限均为建库至 2022 年 8 月。由 2 位研究者按照纳入与排除标准筛选文献、提取资料并评价纳入研究的质量后，采用 RevMan 5.4 统计软件进行分析。主要结局为短期死亡率（28 天死亡率或 ICU 死亡率）；次要结局为 90 天死亡率、ICU 住院时间、总住院时间、ICU 新发器官功能障碍发生率、ICU 新发感染发生率、ICU 获得性肌无力发生率。
共纳入 10 篇文献 5779 例患者，其中保守氧疗组 2886 例、常规氧疗组 2893 例。Meta 分析结果显示，保守氧疗组短期死亡率低于常规氧疗组[RR=0.03，95%CI（0.02，0.05）]。基于不同保守氧疗目标值的亚组分析结果显示，当目标值设定在 90%以上时，保守氧疗组具有显著优势[RR=0.76，95%CI（0.62，0.94），=0.01]；当目标值设定在 90%以下时，两组间差异无统计学意义[RR=0.95，95%CI（0.79，1.16），=0.63]。此外，在 ICU 新发感染发生率[RR=0.03，95%CI（0.01，0.06），=0.001]和 ICU 获得性肌无力发生率[RR=0.03，95%CI（0.01，0.06），=0.001]方面，保守氧疗组也具有优势，差异均有统计学意义。但在 90 天死亡率[RR=0.61，95%CI（0.42，0.90），=0.01]、ICU 住院时间[RR=0.96，95%CI（0.89，1.04），=0.31]、总住院时间[RR=0.47，95%CI（0.27，0.81），=0.005]和 ICU 新发器官功能障碍发生率[RR=0.61，95%CI（0.36，1.03），=0.07]方面，两组间差异无统计学意义。
与常规氧疗相比，保守氧疗可降低危重症患者的短期死亡率，特别是当保守氧疗目标值设定在 90%以上时。同时，它还可以降低 ICU 新发感染和 ICU 获得性肌无力的发生率，而对 90 天死亡率、ICU 住院时间和总住院时间无影响。
