Effect of low-to-moderate hyperoxia on lung injury in preclinical animal models: a systematic review and meta-analysis
Abstract
Background Extensive animal investigation informed clinical practice regarding the harmful effects of high fractional inspired oxygen concentrations (FiO_2s > 0.60). Since questions persist whether lower but still supraphysiologic FiO_2 ≤ 0.60 and > 0.21 (FiO_2 ≤ 0.60/ > 0.21) are also harmful with inflammatory lung injury in patients, we performed a systematic review examining this question in animal models. Methods Studies retrieved from systematic literature searches of three databases, that compared the effects of exposure to FiO_2 ≤ 0.60/ > 0.21 vs. FiO_2 = 0.21 for ≥ 24 h in adult in vivo animal models including an inflammatory challenge or not were analyzed. Survival, body weight and/or lung injury measures were included in meta-analysis if reported in ≥ 3 studies. Results More than 600 retrieved reports investigated only FiO_2s > 0.60 and were not analyzed. Ten studies with an inflammatory challenge (6 infectious and 4 noninfectious) and 14 studies without, investigated FiO_2s ≤ 0.60/ > 0.21 and were analyzed separately. In seven studies with an inflammatory challenge, compared to FiO_2 = 0.21, FiO_2 ≤ 0.60/ > 0.21 had consistent effects across animal types on the overall odds ratio of survival (95%CI) that was on the side of harm but not significant [0.68 (0.38,1.23), p = 0.21; I ^2 = 0%, p = 0.57]. However, oxygen exposure times were only 1d in 4 studies and 2–4d in another. In a trend approaching significance, FiO_2 ≤ 0.60/ > 0.21 with an inflammatory challenge…
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Evidence Hub reads this as a meta-analysis, done in animal, not in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 6 participants or records.
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