Summary of findings 1. Oxygen targets in the intensive care unit during mechanical ventilation for acute respiratory distress syndrome.
| Patients or population: adult (≥ 18 years of age) patients receiving mechanical ventilation (via either an endotracheal tube or a tracheostomy) for acute respiratory distress syndrome (ARDS) (Berlin definition), including ARDS secondary to COVID‐19 or other viruses Settings: intensive care units in: France Intervention: ‘conservative’ oxygen target: PaO2 55 ‐ 70 mmHg or SpO2 88 ‐ 92% Comparison: ‘liberal’ oxygen target: PaO2 90 ‐ 105 mmHg or SpO2 ≥96% | |||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect (95% CI) | Number of participant (studies) | Certainty of the evidence (GRADE) | |
| Liberal oxygen target | Conservative oxygen target | ||||
| Mortality at longest follow‐up (follow‐up: 90 days) | 304 per 1,000 | 444 per 1000 (310 to 588) | OR 1.83 (1.03 to 3.27) | 201 (1 RCT) |
⊕⊝⊝⊝ Very lowa,b |
| Number of days ventilated | Mean number of days ventilated was 14.5 days | MD 0.5 days fewer (0.98 fewer to 0.02 fewer) | ‐ | 201 (1 RCT) |
⊕⊝⊝⊝ Very lowa,b |
| Requirement for inotropic support (scale from 0 to 28, days of catecholamine use) | Mean duration of catecholamine use was 7.2 days | MD 0.8 days more (0.52 more to 1.08 more) | ‐ | 201 (1 RCT) |
⊕⊝⊝⊝ Very lowa,b |
| Requirement for renal replacement therapy (follow‐up: 6 days) | 98 per 1,000 | 101 per 1,000 (43 to 220) | OR 1.03 (0.41 to 2.60) | 201 (1 RCT) |
⊕⊝⊝⊝ Very lowa,b |
| Quality of life | ‐ | ‐ | ‐ | 0 | ‐ |
| CI: confidence interval; MD: mean difference; OR: odds ratio | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
aDowngraded due to serious concerns about risk of bias. High risk of selection bias (open‐label and unblinded) and early stopping bias (stopped prematurely). bDowngraded two levels due to very serious concerns about imprecision. Only one study with a low overall total number of participants included in the review.