TY - JOUR
T1 - Determining a safe upper limit of oxygen supplementation for adult patients
T2 - a systematic review
AU - Lassen, Mathilde Languille
AU - Risgaard, Bjarke
AU - Baekgaard, Josefine S
AU - Rasmussen, Lars S
N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/7/26
Y1 - 2021/7/26
N2 - OBJECTIVE: This systematic review aimed to describe the connection between the inspired oxygen fraction and pulmonary complications in adult patients, with the objective of determining a safe upper limit of oxygen supplementation.METHODS: MEDLINE and Embase were systematically searched in August 2019 (updated July 2020) for studies fulfilling the following criteria: intubated adult patients (Population); high fractions of oxygen (Intervention) versus low fractions of (Comparison); atelectasis, acute respiratory distress syndrome (ARDS), pneumonia and/or duration of mechanical ventilation (Outcome); original studies both observational and interventional (Studies). Screening, data extraction and risk of bias assessment was done by two independent reviewers.RESULTS: Out of 6120 records assessed for eligibility, 12 were included. Seven studies were conducted in the emergency setting, and five studies included patients undergoing elective surgery. Eight studies reported data on atelectasis, two on ARDS, four on pneumonia and two on duration of mechanical ventilation. There was a non-significant increased risk of atelectasis if an oxygen fraction of 0.8 or above was used, relative risk (RR): 1.37 (95% CI 0.95 to 1.96). One study showed an almost threefold higher risk of pneumonia in the high oxygen fraction group (RR: 2.83 (95% CI 2.25 to 3.56)). The two studies reporting ARDS and the two studies with data on mechanical ventilation showed no association with oxygen fraction. Four studies had a high risk of bias in one domain.CONCLUSIONS: In this systematic review, we found inadequate evidence to identify a safe upper dosage of oxygen, but the identified studies suggest a benefit of keeping inspiratory oxygen fraction below 0.8 with regard to formation of atelectases.PROSPERO REGISTRATION NUMBER: CRD42020154242.
AB - OBJECTIVE: This systematic review aimed to describe the connection between the inspired oxygen fraction and pulmonary complications in adult patients, with the objective of determining a safe upper limit of oxygen supplementation.METHODS: MEDLINE and Embase were systematically searched in August 2019 (updated July 2020) for studies fulfilling the following criteria: intubated adult patients (Population); high fractions of oxygen (Intervention) versus low fractions of (Comparison); atelectasis, acute respiratory distress syndrome (ARDS), pneumonia and/or duration of mechanical ventilation (Outcome); original studies both observational and interventional (Studies). Screening, data extraction and risk of bias assessment was done by two independent reviewers.RESULTS: Out of 6120 records assessed for eligibility, 12 were included. Seven studies were conducted in the emergency setting, and five studies included patients undergoing elective surgery. Eight studies reported data on atelectasis, two on ARDS, four on pneumonia and two on duration of mechanical ventilation. There was a non-significant increased risk of atelectasis if an oxygen fraction of 0.8 or above was used, relative risk (RR): 1.37 (95% CI 0.95 to 1.96). One study showed an almost threefold higher risk of pneumonia in the high oxygen fraction group (RR: 2.83 (95% CI 2.25 to 3.56)). The two studies reporting ARDS and the two studies with data on mechanical ventilation showed no association with oxygen fraction. Four studies had a high risk of bias in one domain.CONCLUSIONS: In this systematic review, we found inadequate evidence to identify a safe upper dosage of oxygen, but the identified studies suggest a benefit of keeping inspiratory oxygen fraction below 0.8 with regard to formation of atelectases.PROSPERO REGISTRATION NUMBER: CRD42020154242.
KW - Adult
KW - Humans
KW - Oxygen
KW - Oxygen Inhalation Therapy
KW - Pneumonia
KW - Respiration, Artificial
KW - Respiratory Distress Syndrome/therapy
KW - adult anaesthesia
KW - adult intensive & critical care
KW - respiratory physiology
KW - respiratory medicine (see thoracic medicine)
UR - http://www.scopus.com/inward/record.url?scp=85111411427&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-045057
DO - 10.1136/bmjopen-2020-045057
M3 - Review
C2 - 34312194
SN - 2044-6055
VL - 11
SP - e045057
JO - BMJ Open
JF - BMJ Open
IS - 7
M1 - e045057
ER -