Evidence map›Paper›PMID 29726345›Full record

SynthesisLancet (London, England)2018

Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis.

Derek K Chu, Lisa H-Y Kim, Paul J Young, Nima Zamiri, Saleh A Almenawer, Roman Jaeschke, Wojciech Szczeklik, Holger J Schünemann, John D Neary, Waleed Alhazzani

4 registry-linked trialsOpen access · greenAbstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Lancet (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 339 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
339citing papers in PubMed, 17 pooled it
65.5field-weighted citation impact, top 1% of its field
1 · What the graph read from 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.

2 · The registry

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.

NCT04079465 nacompletednot on this mapstarted 2019, after this paper: background citation

Automated Oxygen Control by O2matic to Patients Admitted With Acute Hypoxemia

TypeinterventionalSponsorHvidovre University HospitalRan2019 to 2023Enrolled30ConditionsHypoxemic Respiratory Failure, Hypoxia, Hypoxemia, Respiratory FailureArmsO2matic
NCT04291911 completednot on this mapstarted 2020, after this paper: background citation

Prospective Multicentre Observational Study on the Incidence of Hyperoxia in Non-intubated Patients in Intensive Care in Belgium Study OxSIZgen

TypeobservationalSponsorSIZ NursingRan2020 to 2020Enrolled300ConditionsHyperoxia
NCT04320056 naunknown statusnot on this mapstarted 2020, after this paper: background citation

Automated Oxygen Titration - Monitoring and Weaning in Patients With Infectious Pneumonia Requiring Oxygen - Impact on the Number of Interventions for Healthcare Workers. An Innovative Device to Manage Patients With COVID-19 Pneumonia COVID Study (Closed-Loop Oxygen to Verify That Healthcare Workers Interventions Decreaseduring Pneumonia)

TypeinterventionalSponsorLaval UniversityRan2020 to 2021Enrolled216ConditionsCoronavirus, Pneumonia, Oxygen ToxicityArmsStandard administration of oxygen flow, Automated oxygen administration - FreeO2
NCT05464277 naterminatednot on this mapstarted 2022, after this paper: background citation

Impact of Intermediate Normal Compared to High Normal Oxygen Levels on Outcomes of Patients Presenting in the Emergency Department With Severe Traumatic Brain Injury (INACHOS): a Pilot Randomized Controlled Trial

TypeinterventionalSponsorEvangelismos HospitalRan2022 to 2024Enrolled1ConditionsTraumatic Brain Injury, Acute Respiratory Failure, Acute Respiratory Distress Syndrome, Acute Brain InjuryArmsOxygen
3 · Its place in the literature

Who cites it

339 citing papers in PubMed, 17 syntheses or guidelines pooled it, 766 citations in OpenAlex.

  1. Manual compared to automated closed-loop oxygen control strategies in hospitalised adults: a systematic review and meta-analysis.European respiratory review : an official journal of the European Respiratory Society · 2026
    Pooled it
  2. Guideline
  3. Pooled it
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  7. 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 · 2025
    Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
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  12. Guideline
  13. Pooled it
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  16. [Oxygen in the acute care of adults : Short version of the German S3 guideline].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2022
    Guideline
  17. Pooled it
  18. Trial
  19. Trial
  20. Trial

279 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 3 countries.

Derek K ChuDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Lisa H-Y KimDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Paul J YoungMedical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.
Nima ZamiriDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Saleh A AlmenawerDivision of Neurosurgery, McMaster University, Hamilton, ON, Canada.
Roman JaeschkeDepartment of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Wojciech SzczeklikDepartment of Medicine, McMaster University, Hamilton, ON, Canada; Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
Holger J SchünemannDepartment of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
John D NearyDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Waleed AlhazzaniDepartment of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. Electronic address: alhazzaw@mcmaster.ca.
McMaster University · CAImpact · CAMedical Research Institute of New Zealand · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSupplemental oxygen is often administered liberally to acutely ill adults, but the credibility of the evidence for this practice is unclear. We systematically reviewed the efficacy and safety of liberal versus conservative oxygen therapy in acutely ill adults.

methodsIn the Improving Oxygen Therapy in Acute-illness (IOTA) systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, HealthSTAR, LILACS, PapersFirst, and the WHO International Clinical Trials Registry from inception to Oct 25, 2017, for randomised controlled trials comparing liberal and conservative oxygen therapy in acutely ill adults (aged ≥18 years). Studies limited to patients with chronic respiratory diseases or psychiatric disease, patients on extracorporeal life support, or patients treated with hyperbaric oxygen therapy or elective surgery were excluded. We screened studies and extracted summary estimates independently and in duplicate. We also extracted individual patient-level data from survival curves. The main outcomes were mortality (in-hospital, at 30 days, and at longest follow-up) and morbidity (disability at longest follow-up, risk of hospital-acquired pneumonia, any hospital-acquired infection, and length of hospital stay) assessed by random-effects meta-analyses. We assessed quality of evidence using the grading of recommendations assessment, development, and evaluation approach. This study is registered with PROSPERO, number CRD42017065697.

findings25 randomised controlled trials enrolled 16 037 patients with sepsis, critical illness, stroke, trauma, myocardial infarction, or cardiac arrest, and patients who had emergency surgery. Compared with a conservative oxygen strategy, a liberal oxygen strategy (median baseline saturation of peripheral oxygen [SpO

interpretationIn acutely ill adults, high-quality evidence shows that liberal oxygen therapy increases mortality without improving other patient-important outcomes. Supplemental oxygen might become unfavourable above an SpO

fundingNone.

Indexed as

AdultAgedAged, 80 and overConservative TreatmentCritical IllnessCross InfectionFemaleHospital MortalityHumansIatrogenic DiseaseLength of StayMaleMiddle AgedMorbidityMyocardial InfarctionOxygenOxygen

Identifiers

PMID29726345
OpenAlexW2801508025

What OpenQuestion holds

Textmetadata
Read underepoch 390

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.