Trial reportThe Lancet. Respiratory medicine2017
Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial.
Trial report in The Lancet. Respiratory medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT05029167 (REstrictive Versus LIberal Oxygen Strategy and Its Effect on Pulmonary Hypertension After Out-of-hospital Cardiac Arrest), which is not on this map. Cited by 128 papers, 16 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
REstrictive Versus LIberal Oxygen Strategy and Its Effect on Pulmonary Hypertension After Out-of-hospital Cardiac Arrest (RELIEPH-study): a Substudy Protocol for a Randomised Clinical Trial
Who cites it
128 citing papers in PubMed, 16 syntheses or guidelines pooled it, 301 citations in OpenAlex.
- Targeting capillary leak in experimental sepsis and endotoxemia: a systematic review of therapeutic agents, methods and models in animal studies.Critical care (London, England) · 2026Pooled it
- Conservative Oxygen Targets in Mechanically Ventilated Patients (OXY-BREATHES): A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Critical care medicine · 2026Pooled it
- Conservative versus liberal oxygen therapy for mechanically ventilated patients: a systematic review and meta-analysis of randomized controlled trials.Frontiers in medicine · 2026Pooled it
- Neurological outcomes and mortality following hyperoxemia in adult patients with acute brain injury: an updated meta-analysis and meta-regression.Critical care (London, England) · 2025Pooled it
- Conservative versus liberal oxygen therapy in mechanically ventilated patients: A systematic review with meta-analysis.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2025Pooled it
- Lower or higher oxygenation targets in the intensive care unit: an individual patient data meta-analysis.Intensive care medicine · 2024Pooled it
- Higher versus lower fractions of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit.The Cochrane database of systematic reviews · 2023Pooled it
- Effects of Conservative Oxygen Therapy versus Conventional Oxygen Therapy on the Mortality in ICU Patients: A Meta-Analysis.Canadian respiratory journal · 2023Pooled it
- Long-term effects of lower versus higher oxygenation levels in adult ICU patients-A systematic review.Acta anaesthesiologica Scandinavica · 2022Pooled it
- [Oxygen in the acute care of adults : Short version of the German S3 guideline].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2022Guideline
- Determining a safe upper limit of oxygen supplementation for adult patients: a systematic review.BMJ open · 2021Pooled it
- The Effect of Conservative Oxygen Therapy in Reducing Mortality in Critical Care Patients: A Meta-Analysis and Trial Sequential Analysis.Frontiers in medicine · 2021Pooled it
- Higher versus lower fraction of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit.The Cochrane database of systematic reviews · 2019Pooled it
- The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis.BMC pulmonary medicine · 2019Pooled it
- Hemodynamic effects of acute hyperoxia: systematic review and meta-analysis.Critical care (London, England) · 2018Pooled it
- Effect of liberal or conservative oxygen therapy on the prognosis for mechanically ventilated intensive care unit patients: a meta-analysis.Sao Paulo medical journal = Revista paulista de medicinaPooled it
- Effects of FiO2 adjustment on hyperoxia biomarkers and postoperative complications using oxygen reserve index during one-lung ventilation.BMC anesthesiology · 2026Trial
- Conservative versus liberal oxygenation targets in critically ill children: the Oxy-PICU RCT.Health technology assessment (Winchester, England) · 2026Trial
- Effect of targeting normoxemia on supplemental oxygen-free days for adults with acute thermal burns: A stepped wedge cluster randomized clinical trial.The journal of trauma and acute care surgery · 2025Trial
- Targeted Normoxemia and Supplemental Oxygen-Free Days in Critically Injured Adults: A Stepped-Wedge Cluster Randomized Clinical Trial.JAMA network open · 2025Trial
68 more citing papers are in PubMed but not listed here.
Corrections and comments
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- Erratum issuedCorrections.2017
Authors and funding
29 authors at 19 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is insufficient research into the use of mechanical ventilation with increased inspiratory oxygen concentration (FiO
methodsThis two-by-two factorial, multicentre, randomised, clinical trial (HYPERS2S) recruited patients aged 18 years and older with septic shock who were on mechanical ventilation from 22 centres in France. Patients were randomly assigned 1:1:1:1 to four groups by a computer generated randomisation list stratified by site and presence or absence of acute respiratory distress syndrome by use of permuted blocks of random sizes. Patients received, in an open-labelled manner, mechanical ventilation either with FiO
findingsBetween Nov 3, 2012, and June 13, 2014, 442 patients were recruited and assigned to a treatment group (normoxia [n=223] or hyperoxia [n=219]; isotonic [n=224] or hypertonic [n=218]). The trial was stopped prematurely for safety reasons. 28 day mortality was recorded for 434 patients; 93 (43%) of 217 patients had died in the hyperoxia group versus 77 (35%) of 217 patients in the normoxia group (hazard ratio [HR] 1·27, 95% CI 0·94-1·72; p=0·12). 89 (42%) of 214 patients had died in the hypertonic group versus 81 (37%) of 220 patients in the isotonic group (HR 1·19, 0·88-1·61; p=0·25). We found a significant difference in the overall incidence of serious adverse events between the hyperoxia (185 [85%]) and normoxia groups (165 [76%]; p=0·02), with a clinically relevant doubling in the hyperoxia group of the number of patients with intensive care unit-acquired weakness (24 [11%] vs 13 [6%]; p=0·06) and atelectasis (26 [12%] vs 13 [6%]; p=0·04) compared with the normoxia group. We found no statistical difference for serious adverse events between the two saline groups (p=0·23).
interpretationIn patients with septic shock, setting FiO
fundingThe French Ministry of Health.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.