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Meta-Analysis
. 2014 Dec 23;18(6):711.
doi: 10.1186/s13054-014-0711-x.

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

Elisa Damiani  1 , Erica Adrario  2 , Massimo Girardis  3 , Rocco Romano  4 , Paolo Pelaia  5 , Mervyn Singer  6 , Abele Donati  7
Affiliations
Meta-Analysis

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

Elisa Damiani et al. Crit Care. .

Abstract

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 O2 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 PaO2 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.

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Figures

Figure 1
Figure 1
Flow chart representing the selection process of the studies included in the qualitative and quantitative syntheses.
Figure 2
Figure 2
Forest plot showing individual odds ratios for mortality of studies on general populations of mechanically ventilated ICU patients (k = 4). Odds ratios >1 (right side of the plot) indicate an association between hyperoxia and higher mortality. Heterogeneity was Q (3) 91.85, P <0.001; I 2 = 96.73. The size of the boxes is inversely proportional to the size of the result study variance, so that more precise studies have larger boxes. k, number of studies; ES, effect size; CI, confidence interval; Sig., P value.
Figure 3
Figure 3
Forest plot showing individual and pooled odds ratios for mortality of studies on patients resuscitated from cardiac arrest. Odds ratios >1 (right side of the plot) indicate an association between hyperoxia and higher mortality. Heterogeneity was Q (4) = 12.4, P = 0.015; I 2 = 67.73. The size of the boxes is inversely proportional to the size of the result study variance; more precise studies have larger boxes. ES, effect size; CI, confidence interval; W, weight; Sig., P value.
Figure 4
Figure 4
Forest plot showing individual and pooled odds ratios for mortality of studies on patients with stroke. Odds ratios >1 (right side of the plot) indicate an association between hyperoxia and higher mortality. Heterogeneity was Q (1) = 0.04, P = 0.844, I 2 = 0. The size of the boxes is inversely proportional to the size of the result study variance, so that more precise studies have larger boxes. ES, effect size; CI, confidence interval; W, weight; Sig., P value.
Figure 5
Figure 5
Forest plot showing individual and pooled odds ratio for mortality of studies on patients with traumatic brain injury. Odds ratios >1 (right side of the plot) indicate an association between hyperoxia and higher mortality. Heterogeneity was Q (4) = 11.28, P = 0.024; I 2 = 64.54. The size of the boxes is inversely proportional to the size of the result study variance; more precise studies have larger boxes. ES, effect size; CI, confidence interval; W, weight; Sig., P value.
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