Critical Care volume 29,
Article number: 50 (2025)
Published: 28 January 2025
Abstract
Oxygen therapy is
ubiquitous in critical illness but oxygenation targets to guide therapy remain
controversial despite several large randomised controlled trials (RCTs).
Findings from RCTs evaluating different approaches to oxygen therapy in
critical illness present a confused picture for several reasons. Differences in
both oxygen target measures (e.g. oxygen saturation or partial pressure) and
the numerical thresholds used to define lower and higher targets complicate
comparisons between trials. The duration of and adherence to oxygenation
targets is also variable with consequent substantial variation in both the dose
and the dose separation. Finally, heterogeneity of treatment effects (HTE) may
also be a significant factor. HTE is defined as non-random variation in the
benefit or harm of a treatment, in which the variation is associated with or
attributable to patient characteristics. This narrative review aims to make the
case that such heterogeneity is likely in relation to oxygen therapy for
critically ill patients and that this has significant implications for the
design and interpretation of trials of oxygen therapy in this context. HTE for
oxygen therapy amongst critically ill patients may explain the contrasting
results from different clinical trials of oxygen therapy. Individualised oxygen
therapy may overcome this challenge, and future studies should incorporate ways
to evaluate this approach.
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