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Table 1 Studies assessing the clinical effects of arterial hyperoxia or supplemental oxygen in subgroups of critically ill patients

From: Bench-to-bedside review: the effects of hyperoxia during critical illness

Author

Country

Study type

Inclusion period

Subgroup

Sample size

Harm

Conclusions

Eastwood et al. [57] (2012)

Australia and New Zealand

Cohort

2000–2009

MV

152,680

–

Hypoxia in first 24 h of admission was associated with increased in-hospital mortality, but hyperoxia was not.

de Jonge et al. [56] (2008)

The Netherlands

Cohort

1999–2006

MV

36,307

+

High FiO2 and both low PaO2 and high PaO2 in first 24 h of admission were associated with in-hospital mortality

Suzuki et al. [96] (2014)

Australia

Before-after pilot

2012

MV

105

+/–

Conservative oxygen therapy in mechanically ventilated ICU patients was feasible and free of adverse biochemical, physiological, or clinical outcomes while allowing a marked decrease in excess oxygen exposure

Aboab et al. [41] (2006)

France

Experimental

NA

ARDS

14

+/–

In mechanically ventilated patients with ARDS, the breathing of pure oxygen leads to alveolar derecruitment, which is prevented by high PEEP

Austin et al. [53] (2010)

Australia

RCT

2006–2007

COPD

405

+

Titrated oxygen treatment significantly reduced mortality, hypercapnia, and respiratory acidosis compared with high-flow oxygen in acute exacerbations of COPD

Cameron et al. [55] (2012)

New Zealand

Cohort

2005–2008

COPD

180

+

Serious adverse clinical outcomes are associated with both hypoxaemia and hyperoxaemia during acute exacerbations

Perrin et al. [54] (2011)

New Zealand

RCT

2007–2009

Asthma

106

+

High-concentration oxygen therapy causes a clinically significant increase in transcutaneous CO2 during severe exacerbations

Bellomo et al. [63] (2011)

Australia and New Zealand

Cohort

2000–2009

CA

12,108

–

Hyperoxia did not have a robust or consistently reproducible association with mortality

Elmer et al. [62] (2014)

USA

Cohort

2008–2010

CA

184

+

Severe hyperoxia was independently associated with decreased survival to hospital discharge

Ihle et al. [64] (2013)

Australia

Cohort

2007–2011

CA

584

–

Hyperoxia within the first 24 h was not associated with increased hospital mortality

Janz et al. [61] (2012)

USA

Cohort

2007–2012

CA

170

+

Higher levels of the maximum measured PaO2 were associated with increased in-hospital mortality and poor neurological status on hospital discharge

Kilgannon et al. [59] (2010)

USA

Cohort

2001–2005

CA

6326

+

Arterial hyperoxia was independently associated with increased in-hospital mortality compared with either hypoxia or normoxia

Kilgannon et al. [60] (2011)

USA

Cohort substudy

2001–2005

CA

4459

+

Supranormal oxygen tension was dose-dependently associated with the risk of in-hospital death

Kuisma et al. [69] (2006)

Finland

RCT pilot

NA

CA

28

–

No indication that 30 % oxygen with SpO2 monitoring did worse than the group receiving 100 % oxygen

Lee et al. [65] (2014)

Korea

Cohort

2008–2012

CA

213

–

Mean PaO2 was not independently associated with in-hospital mortality

Nelskyla et al. [112] (2013)

Australia

Cohort

2008–2010

CA

122

–

No statistically significant differences in numbers of patients discharged from the hospital and 30-day survival between patients with hyperoxia exposure and no exposure

Spindelboeck et al. [67] (2013)

Austria

Cohort

2003–2010

CA

145

–

Increasing PaO2 was associated with a significantly increased rate of hospital admission and not with harmful effects

Vaahersalo et al. [66] (2014)

Finland

Cohort

2010–2011

CA

409

–

Hypercapnia was associated with good 12-month outcome, but harm from hyperoxia exposure was not verified

Minana et al. [113] (2011)

Spain

Cohort

2003–2009

ADHF

588

–

Admission PaO2 was not associated with all-cause long-term mortality

Ranchord et al. [114] (2012)

New Zealand

RCT pilot

2007–2009

STEMI

136

–

No evidence of benefit or harm from high-concentration compared with titrated oxygen

Stub et al. [78] (2012)

Australia

RCT

2011–2014

STEMI

441

+

Supplemental oxygen therapy in patients with STEMI but without hypoxia increased myocardial injury, recurrent myocardial infarction, and cardiac arrhythmia and was associated with larger myocardial infarct size at 6 months. Further results anticipated.

Sutton et al. [115] (2014)

Australia and New Zealand

Cohort

2003–2012

Post cardiac surgery

83,060

–

No association between mortality and hyperoxia in the first 24 h in ICU after cardiac surgery

Ukholkina et al. [80] (2005)

Russia

RCT

NA

AMI

137

–

Inhalation of 30–40 % oxygen within 30 min prior to endovascular myocardial reperfusion and within 4 h thereafter reduced the area of necrosis and peri-infarction area, improved central hemodynamics, and decreased the rate of post-operative rhythm disorders as compared with patients breathing ambient air

Zughaft et al. [116] (2013)

Sweden

RCT

NA

ACS

300

–

The use of oxygen during PCI did not demonstrate any analgesic effect and no difference in myocardial injury measured with troponin- t or in the morphine dose

Asher et al. [89] (2013)

USA

Cohort

NA

TBI

193

–

PaO2 threshold between 250 and 486 mm Hg during the first 72 h after injury was associated with improved all-cause survival independently of hypocarbia or hypercarbia

Brenner et al. [88] (2012)

USA

Cohort

2002–2007

TBI

1547

+

Hyperoxia within the first 24 h of hospitalization was associated with worse short-term functional outcomes and higher mortality

Davis et al. [87] (2009)

USA

Cohort

1987–2003

TBI

3420

+

Both hypoxemia and extreme hyperoxemia were associated with increased mortality and a decrease in good outcomes

Quintard et al. [83] (2014)

Switzerland

Cohort

2009–2013

TBI

36

+

Incremental normobaric FiO2 levels were associated with increased cerebral excitotoxicity independently from brain tissue oxygen and other important cerebral and systemic determinants

Raj et al. [90] (2013)

Finland

Cohort

2003–2012

TBI

1116

–

Hyperoxemia in the first 24 h of admission was not predictive of 6-month mortality

Rincon et al. [92] (2013)

USA

Cohort

2003–2008

TBI

1212

+

Arterial hyperoxia was independently associated with higher in-hospital case fatality

Jeon et al. [84] (2014)

USA

Cohort

1996–2011

Stroke

252

+

Exposure to hyperoxia was associated with delayed cerebral ischemia

Rincon et al. [85] (2014)

USA

Cohort

2003–2008

Stroke

2894

+

Arterial hyperoxia was independently associated with in-hospital death as compared with either normoxia or hypoxia

Ali et al. [82] (2014) and Roffe et al. [117] (2011)

UK

RCT pilot

2004–2008

Stroke

289

–

Routine oxygen supplementation started within 24 h of hospital admission with acute stroke led to a small improvement in neurological recovery at 1 week, but no outcome differences were observed at 6 months

Ronning et al. [81] (1999)

Norway

Quasi-RCT

1994–1995

Stroke

310

+

Supplemental oxygen should not routinely be given to non-hypoxic patients with minor or moderate strokes

Singhal et al. [118] (2005)

USA

RCT pilot

NA

Stroke

16

–

High-flow oxygen therapy is associated with a transient improvement of clinical deficits and MRI abnormalities

Young et al. [91] (2012)

Australia and New Zealand

Cohort

2000–2009

Stroke

2643

–

Worst arterial oxygen tension in the first 24 h was not associated with outcome

Stolmeijer et al. [119] (2014)

The Netherlands

Cohort

NA

Sepsis

83

–

No association between mortality and hyperoxia, nor between lower FiO2 and other detrimental effects

  1. NA, not available; +, study found harm from supplemental oxygen or arterial hyperoxia; –, no harm found from supplemental oxygen or arterial hyperoxia
  2. ACS Acute coronary syndrome, ADHF Acute decompensated heart failure, AMI Acute myocardial infarction, ARDS Acute respiratory distress syndrome, CA Cardiac arrest, CO2 Carbon dioxide, COPD Chronic obstructive pulmonary disease, FiO2 Fraction of inspired oxygen, ICU Intensive care unit, MRI Magnetic resonance imaging, PaO2 Partial pressure of arterial oxygen, PCI Percutaneous coronary intervention, MV Mechanical ventilation, PEEP Positive end-expiratory pressure, RCT Randomized control trial, SpO2 Oxyhemoglobin saturation, STEMI ST-segment elevation myocardial infarction, TBI Traumatic brain injury