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Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis

INTRODUCTION: The 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. METHODS: Medline, Thomson Reuters Web of Science and...

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Autores principales: Damiani, Elisa, Adrario, Erica, Girardis, Massimo, Romano, Rocco, Pelaia, Paolo, Singer, Mervyn, Donati, Abele
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298955/
https://www.ncbi.nlm.nih.gov/pubmed/25532567
http://dx.doi.org/10.1186/s13054-014-0711-x
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author Damiani, Elisa
Adrario, Erica
Girardis, Massimo
Romano, Rocco
Pelaia, Paolo
Singer, Mervyn
Donati, Abele
author_facet Damiani, Elisa
Adrario, Erica
Girardis, Massimo
Romano, Rocco
Pelaia, Paolo
Singer, Mervyn
Donati, Abele
author_sort Damiani, Elisa
collection PubMed
description INTRODUCTION: The 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. METHODS: Medline, 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 O(2) 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. RESULTS: In 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 PaO(2) 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(2)) 96.73%). Hyperoxia was associated with increased mortality in post-cardiac arrest patients (OR = 1.42 (1.04 to 1.92) I(2) 67.73%) stroke (OR = 1.23 (1.06 to 1.43) I(2) 0%) and traumatic brain injury (OR = 1.41 (1.03 to 1.94) I(2) 64.54%). However, these results are limited by significant heterogeneity between studies. CONCLUSIONS: Hyperoxia 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The 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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spelling pubmed-42989552015-01-21 Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis Damiani, Elisa Adrario, Erica Girardis, Massimo Romano, Rocco Pelaia, Paolo Singer, Mervyn Donati, Abele Crit Care Research INTRODUCTION: The 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. METHODS: Medline, 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 O(2) 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. RESULTS: In 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 PaO(2) 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(2)) 96.73%). Hyperoxia was associated with increased mortality in post-cardiac arrest patients (OR = 1.42 (1.04 to 1.92) I(2) 67.73%) stroke (OR = 1.23 (1.06 to 1.43) I(2) 0%) and traumatic brain injury (OR = 1.41 (1.03 to 1.94) I(2) 64.54%). However, these results are limited by significant heterogeneity between studies. CONCLUSIONS: Hyperoxia 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-014-0711-x) contains supplementary material, which is available to authorized users. BioMed Central 2014-12-23 2014 /pmc/articles/PMC4298955/ /pubmed/25532567 http://dx.doi.org/10.1186/s13054-014-0711-x Text en © Damiani et al.; licensee BioMed Central. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Damiani, Elisa
Adrario, Erica
Girardis, Massimo
Romano, Rocco
Pelaia, Paolo
Singer, Mervyn
Donati, Abele
Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis
title Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis
title_full Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis
title_fullStr Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis
title_full_unstemmed Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis
title_short Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis
title_sort arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298955/
https://www.ncbi.nlm.nih.gov/pubmed/25532567
http://dx.doi.org/10.1186/s13054-014-0711-x
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