Effects of conservative versus liberal oxygen treatment in mortality of UCI patients
DOI:
https://doi.org/10.56294/piii2023152Keywords:
Conservative oxygen therapy, conservative oxygen therapy and mortality, conservative oxygen therapy and critical care, conservative oxygen therapy and critically ill, conversative oxygen therapy and intensive care unitAbstract
Background: The oxygen is a drug that is commonly used in clinical practice and whose therapeutic use has been adjusted over time. However, this practice confronts us with one of the transcendental problems, which is the inconsistency of the optimal oxygen level established in the clinical practice guidelines. Currently the treatment is liberal and leads to abnormally high levels of oxygen causing damage locally and systemically. The consequence of this is increased mortality in patients who are treated with high levels of oxygen. In view of this, conservative therapy was proposed to avoid hyperoxemia and mitigate its adverse effects. The optimal level of oxygen for the treatment of patients admitted to the intensive care unit remains uncertain. Material and methods: A comprehensive electronic search of the relevant literature on conservative and liberal treatment in intensive care unit inpatients was performed through medical databases as well as reference search engines such as Pubmed, Cochrane, trip, epistemonikos, Australian New Zealand clinical trial registry and clinicaltrial.gov. For this, the following keywords and MESH terms were used: “conservative oxygen therapy”, “conservative oxygen therapy and mortality”, “conservative oxygen therapy and critical care”, “conservative oxygen therapy and critically ill”. Randomized clinical trials, systematic reviews, and meta-analyses were identified without considering publication status, reported results, date or year of publication, and language. Results: Were included 21 systematic review and meta-analysis papers that compared liberal with conservative treatment and were within the inclusion criteria and 13 randomized clinical trials. Conclusion: Currently, the available evidence on targeted oxygen therapy in intensive care patients remains inconclusive. More randomized clinical trials are needed to determine the ideal oxygen target for intensive care patients and its impact on mortality)
References
Piraino T, Madden M, Roberts KJ, Lamberti J, Ginier E, Strickland SL. AARC Clinical Practice Guideline: Management of Adult Patients With Oxygen in the Acute Care Setting. Respir Care. janeiro de 2022;67(1):115–28.
McDonald V, Cousins J, Wark P. Acute oxygen therapy: a review of prescribing and delivery practices. COPD. maio de 2016;1067.
Nakane M. Biological effects of the oxygen molecule in critically ill patients. j intensive care. dezembro de 2020;8(1):95.
Angus DC. Oxygen Therapy for the Critically Ill. N Engl J Med. 12 de março de 2020;382(11):1054–6.
Helmerhorst HJF. Optimal Oxygenation: Exploring the Boundaries. Annals ATS. agosto de 2022;19(8):1270–1.
Grim CCA, van der Wal LI, Helmerhorst HJF, van Westerloo DJ, Pelosi P, Schultz MJ, et al. ICONIC study—conservative versus conventional oxygenation targets in intensive care patients: study protocol for a randomized clinical trial. Trials. dezembro de 2022;23(1):136.
Chu DK, Kim LHY, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. The Lancet. abril de 2018;391(10131):1693–705.
O’Driscoll BR, Howard LS, Davison AG, on behalf of the British Thoracic Society. BTS guideline for emergency oxygen use in adult patients. Thorax. 1o de outubro de 2008;63(Supplement 6):vi1–68.
Barnett A, Beasley R, Buchan C, Chien J, Farah CS, King G, et al. Thoracic Society of Australia and New Zealand Position Statement on Acute Oxygen Use in Adults: ‘Swimming between the flags’. Respirology. abril de 2022;27(4):262–76.
Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, et al. German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients. Respiration. 2022;101(2):214–52.
Crescioli E, Klitgaard TL, Poulsen LM, Brand BA, Siegemund M, Grøfte T, et al. Long-term mortality and health-related quality of life of lower versus higher oxygenation targets in ICU patients with severe hypoxaemia. Intensive Care Med. junho de 2022;48(6):714–22.
Siemieniuk RAC, Chu DK, Kim LHY, Güell-Rous MR, Alhazzani W, Soccal PM, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 24 de outubro de 2018;k4169.
Young PJ, Frei D. Oxygen therapy for critically Ill and post-operative patients. J Anesth. dezembro de 2021;35(6):928–38.
Girardis M, Alhazzani W, Rasmussen BS. What’s new in oxygen therapy? Intensive Care Med. julho de 2019;45(7):1009–11.
Dong WH, Yan WQ, Chen Z. Effect of liberal or conservative oxygen therapy on the prognosis for mechanically ventilated intensive care unit patients: a meta-analysis. Sao Paulo Med J. junho de 2022;140(3):463–73.
Chu DK, Kim LHY, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. The Lancet. abril de 2018;391(10131):1693–705.
Klitgaard TL, Schjørring OL, Lange T, Møller MH, Perner A, Rasmussen BS, et al. Lower versus higher oxygenation targets in critically ill patients with severe hypoxaemia: secondary Bayesian analysis to explore heterogeneous treatment effects in the Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial. British Journal of Anaesthesia. janeiro de 2022;128(1):55–64.
van der Wal LI, Grim CCA, van Westerloo DJ, Schultz MJ, de Jonge E, Helmerhorst HJF. Higher versus lower oxygenation strategies in the general intensive care unit population: A systematic review, meta-analysis and meta-regression of randomized controlled trials. Journal of Critical Care. dezembro de 2022;72:154151.
Ni YN, Wang T, Liang BM, Liang ZA. The Effect of Conservative Oxygen Therapy in Reducing Mortality in Critical Care Patients: A Meta-Analysis and Trial Sequential Analysis. Front Med. 10 de dezembro de 2021;8:738418.
Chen XL, Zhang BL, Meng C, Huang HB, Du B. Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials. j intensive care. dezembro de 2021;9(1):47.
Hirase T, Ruff ES, Ratnani I, Surani S. Impact of Conservative Versus Conventional Oxygenation on Outcomes of Patients in Intensive Care Units: A Systematic Review and Meta-analysis. Cureus [Internet]. 15 de setembro de 2019 [citado 23 de janeiro de 2023]; Disponível em: https://www.cureus.com/articles/20802-impact-ofconservative-versus-conventional-oxygenation-onoutcomes-of-patients-in-intensive-care-units-asystematic-review-and-meta-analysis
Young PJ, Bailey M, Bellomo R, Bernard S, Bray J, Jakkula P, et al. Conservative or liberal oxygen therapy in adults after cardiac arrest. Resuscitation. dezembro de 2020;157:15–22.
Suzuki S, Eastwood GM, Glassford NJ, Peck L, Young H, Garcia-Alvarez M, et al. Conservative Oxygen Therapy in Mechanically Ventilated Patients: A Pilot Before-and-After Trial*. Critical Care Medicine. junho de 2014;42(6):1414–22.
Grensemann J, Fuhrmann V, Kluge S. Oxygen Treatment in Intensive Care and Emergency Medicine. Deutsches Ärzteblatt international [Internet]. 9 de julho de 2018 [citado 24 de janeiro de 2023]; Disponível em: https://www.aerzteblatt.de/10.3238/arztebl.2018.0
Panwar R, Hardie M, Bellomo R, Barrot L, Eastwood GM, Young PJ, et al. Conservative versus Liberal Oxygenation Targets for Mechanically Ventilated Patients. A Pilot Multicenter Randomized Controlled Trial. Am J Respir Crit Care Med. 1o de janeiro de 2016;193(1):43–51.
Carr AC, Spencer E, Mackle D, Hunt A, Judd H, Mehrtens J, et al. The effect of conservative oxygen therapy on systemic biomarkers of oxidative stress in critically ill patients. Free Radical Biology and Medicine. novembro de 2020;160:13–8.
The ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Conservative Oxygen Therapy during Mechanical Ventilation in the ICU. N Engl J Med. 12 de março de 2020;382(11):989–98.
Young P, Mackle D, Bellomo R, Bailey M, Beasley R, Deane A, et al. Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy. Intensive Care Med. dezembro de 2020;46(12):2411–22.
Barrot L, Asfar P, Mauny F, Winiszewski H, Montini F, Badie J, et al. Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome. N Engl J Med. 12 de março de 2020;382(11):999– 1008.
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Copyright (c) 2023 Carolina da Rocha Simões, Matías Accoce (Author)
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