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Research Snapshot Theater: Pharmacology/Pulmonary, Adult

Conservative vs Liberal Oxygen Target in Mechanically Ventilated Patients: A Meta-Analysis

Tuesday, March 24, 2026
12:30 PM - 1:30 PM Central Time
Location: Connections Central - RST 08

  • Nhan Nguyen, MD (he/him/his)

    Hungary

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • NT

    Nghi Tran Bao, n/a

    Medical Student
    University of Debrecen, Faculty of Medicine

    Disclosure information not submitted.

  • NA

    Nathalia Alves de Barros e Lyra, MD

    Resident
    Faculdade Pernambucana de Saude, Recife. Pernambuco, Brazi, Pernambuco, Brazil

    Disclosure information not submitted.

  • YZ

    Yacin Zawam, MD FACP

    Doctor
    Southern Ohio Medical Center

    Disclosure information not submitted.

  • DD

    David Downes, N/A

    Medical Student
    The University of New England, Department of Rural Medicine, Armidale, Australia., New South Wales, Australia

    Disclosure information not submitted.

  • VN

    Vy Ngoc Dan Nguyen, N/A

    Medical Student
    The University of Melbourne, Department of Nursing, Melbourne, Australia, Victoria, Australia

    Disclosure information not submitted.

  • VH

    Vinh Ho Quang Tri, N/A

    Medical Student
    University of Debrecen, Faculty of Medicine, Hajdu-Bihar, Hungary

    Disclosure information not submitted.

  • HL

    Ha Le Duc Thien, N/A

    Medical Student
    University of Debrecen, Faculty of Medicine, Hajdu-Bihar, Hungary

    Disclosure information not submitted.

  • JA

    Jafar Aljazeeri, MD, FCCP

    Doctor
    University of Pittsburgh Medical Center

    Disclosure information not submitted.

Introduction: In intensive care units (ICUs), oxygen therapy has shifted toward conservative targets over concerns that liberal oxygenation may increase mortality. However, recent RCTs report conflicting results in ventilated patients.


Methods: We conducted a meta-analysis (OXY-BREATHES) of RCTs comparing conservative (SpO₂ 88–94% or PaO₂ < 80 mmHg) versus liberal oxygen targets (SpO₂ ≥94% or PaO₂ ≥90 mmHg) in mechanically ventilated ICU patients. Databases searched included PubMed, Cochrane CENTRAL, Embase, and ClinicalTrials.gov. Primary outcomes were 30-day, 90-day, and ICU mortality. Secondary outcomes included ventilator- and vasopressor-free days, renal replacement therapy, ICU length of stay, nosocomial pneumonia, and cardiac or cerebral ischemic events. Prespecified subgroup analyses included patients with sepsis/septic shock; exploratory analyses included those with brain injury and post–cardiac arrest.


Results: Eight RCTs enrolling 19,658 patients were included. Conservative versus liberal oxygen targets showed no significant differences in 30-day (RR 1.02; 95% CI, 0.97–1.07), 90-day (RR 1.03; 95% CI, 0.93–1.13), or ICU mortality (RR 1.02; 95% CI, 0.97–1.06). Secondary outcomes, including ICU length of stay and adverse events, were similar. Conservative targets yielded more vasopressor-free days (SMD 0.17; p =0.008) in septic patients and a potential survival benefit in post–cardiac arrest patients (RR 0.89; p =0.04).


Conclusions: This meta-analysis suggests conservative oxygen targets provide comparable mortality and safety outcomes to liberal targets in mechanically ventilated ICU patients, with possible benefits in select subgroups.
(OXY-BREATHES was registered on PROSPERO, under ID: CRD420251082611)