March 1, 1996Critical Care Medicine
Maximizing oxygen delivery in critically ill patients
Authors
Discussion
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Implication
Systematic review finds supraphysiologic oxygen delivery does not improve survival in critically ill patients, indicating potential benefits may be restricted to preoperative initiation.
Key Points
- To systematically evaluate whether hemodynamic interventions designed to achieve supraphysiologic cardiac index, oxygen delivery, and oxygen consumption reduce mortality in critically ill patients.
- Systematic review and meta-analysis of 7 randomized clinical trials comprising 1,016 adult intensive care unit patients.
- Assessed protocols administering intravenous fluids, inotropes, and vasoactive drugs to reach supraphysiologic endpoints compared to control therapy.
- Supraphysiologic hemodynamic goals showed a non-statistically significant trend toward reduced overall mortality (RR 0.86, 95% CI 0.62–1.20).
- Preoperatively initiated protocols significantly reduced mortality (RR 0.20, 95% CI 0.07–0.55), whereas initiation after ICU admission showed no benefit (RR 0.98, 95% CI 0.79–1.22; p < 0.01).
- Significant methodological limitations were identified across studies, including an absence of blinding, intention-to-treat analysis in only 3 of 7 trials, and substantial patient crossover between arms.
Cite This Study
Heyland et al. (1996) studied this question.