xisting literature to assess the effects of lower and higher oxygenation targets on the mortality rates of critically ill intensive care unit (ICU) patients. METHODS: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched from their dates of inception to December 31, 2022, for randomized controlled trials (RCTs) comparing lower and higher oxygenation targets for critically ill patients ≥18 years of age undergoing mechanical ventilation, nasal cannula, oxygen mask, or high-flow oxygen therapy in the ICU. Data extraction was conducted independently, and RoB 2.0 software was used to evaluate the quality of each RCT. A random-effects model was used for the meta-analysis to calculate the relative risk (RR). We used the I2 statistic as a measure of statistical heterogeneity. Certainty of evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. RESULTS: We included 12 studies with a total of 7416 patients participating in RCTs. Oxygenation targets were extremely heterogeneous between studies. The meta-analysis found no differences in mortality between lower and higher oxygenation targets for critically ill ICU patients (relative risk [RR], 1.00; 95% confidence interval [CI], 0.93–1.09; moderate certainty). The incidence of serious adverse events (RR, 0.93; 95% CI, 0.85–1.00; high certainty), mechanical ventilation-free days through day 28 (mean difference [MD], −0.05; 95%CI, −1.23 to 1.13; low certainty), the number of patients requiring renal replacement therapy (RRT) (RR, 0.96; 95% CI, 0.84–1.10; low certainty), and ICU length of stay (MD, 1.05; 95% CI, −0.04 to 2.13; very low certainty) also did not differ among patients with lower or higher oxygenation targets. CONCLUSIONS: Critically ill ICU patients ≥18 years of age managed with lower and higher oxygenation targets did not differ in terms of mortality, RRT need, mechanical ventilation-free days through day 28, or ICU length of stay. However, due to considerable heterogeneity between specific targets in individual studies, no conclusion can be drawn regarding the effect of oxygenation targets on ICU outcomes....

中文翻译：

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氧合目标对重症监护病房危重患者死亡率的影响：系统评价和荟萃分析


寻找文献来评估较低和较高的氧合目标对危重症重症监护病房 （ICU） 患者死亡率的影响。方法： 检索了 MEDLINE 、 EMBASE 、 Cochrane 对照试验中心注册库和 Web of Science 数据库，从建库之日到 2022 年 12 月 31 日，以比较 ICU 中接受机械通气、鼻插管、氧气面罩或高流量氧疗的危重患者 ≥ 的较低和较高氧合目标。独立进行资料提取，使用 RoB 2.0 软件评价每项 RCT 的质量。采用随机效应模型进行荟萃分析，计算相对风险 （RR）。我们使用 I2 统计量作为统计异质性的量度。根据建议分级评估、开发和评价 （GRADE） 指南评估证据质量。结果： 我们纳入了 12 项研究，共有 7416 例患者参与了 RCT。研究之间的氧合目标存在极强的异质性。荟萃分析发现，危重症 ICU 患者的低氧合目标和高氧合目标之间的死亡率没有差异（相对风险 [RR]，1.00;95% 置信区间 [CI]，0.93-1.09;中等质量）。严重不良事件的发生率（RR，0.93;95% CI，0.85-1.00;高质量）、截至第 28 天的无机械通气天数（平均差 [MD]，-0.05;95%CI，-1.23 至 1.13;低质量）、需要肾脏替代治疗 （RRT） 的患者人数（RR，0.96;95% CI，0.84-1.10;低质量）和 ICU 住院时间（MD，1.05;95% CI， −0.04 到 2。13;极低质量证据）在氧合目标较低或较高的患者中也没有差异。结论： 以较低和较高的氧合目标管理的危重症 ICU 患者 ≥18 岁）在死亡率、RRT 需求、第 28 天至第 28 天的无机械通气天数或 ICU 住院时间方面没有差异。然而，由于个别研究中特定目标之间存在相当大的异质性，因此无法得出关于氧合目标对 ICU 结果的影响的结论。