• Lea Imeen van der Wal, Chloe C A Grim, David J van Westerloo, Marcus J Schultz, Evert de Jonge, and HelmerhorstHendrik J FHJFDepartment of Intensive Care, Leiden University Medical Centre, Leiden, the Netherlands; Department of Anesthesiology, Leiden University Medical Centre, Leiden, the Netherlands..
• Department of Intensive Care, Leiden University Medical Centre, Leiden, the Netherlands; Department of Anesthesiology, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: l.i.van_der_wal@lumc.nl.
• J Crit Care. 2022 Dec 1; 72: 154151154151.

PurposeOxygen therapy is vital in adult intensive care unit (ICU) patients, but it is indistinct whether higher or lower oxygen targets are favorable. Our aim was to update the findings of randomized controlled trials (RTCs) comparing higher and lower oxygen strategies.Materials And MethodsMEDLINE, EMBASE, and Web of Science were searched. RCTs comparing higher (liberal, hyperoxia) and lower (conservative, normoxia) oxygen in adult mechanically ventilated ICU patients were included. The main outcome was 90-day mortality; other outcomes include serious adverse events (SAE), support free days and length of stay (LOS).ResultsNo significant difference was observed for 90-day mortality. A lower incidence was found for SAEs, favoring lower oxygenation (OR, 0.86; 95%CI, 0.77-0.96; I 2 13%). No differences were observed in either support free days at day 28 or ICU and hospital LOS.ConclusionsNo difference was found for 90-day mortality, support free days and ICU and hospital LOS. However, a lower incidence of SAEs was found for lower oxygenation. These findings may have clinical implications for practice guidelines, yet it remains of paramount importance to continue conducting clinical trials, comparing groups with a clinically relevant contrast and focusing on the impact of important side effects.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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