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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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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. |
format | Online Article Text |
id | pubmed-4298955 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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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