由于先前试验设计存在很大差异，重症监护病房 (ICU) 中急性低氧性呼吸衰竭患者的最佳氧合目标尚未明确确定。本研究旨在对 ICU 处理氧合目标 (HOT-ICU) 和 2019 年冠状病毒病 (COVID-19) 处理氧合目标 (HOT-COVID) 试验进行预先指定的个体患者数据荟萃分析，以进行比较将成年 ICU 患者的动脉氧分压 (PaO2) 设定为 8-12 kPa，评估其益处和危害。我们使用广义混合模型评估了 90 天全因死亡率和 90 天内无生命支持的存活天数。在 14 个亚组中评估了治疗效果 (HTE) 的异质性，并使用评估效果修正分析可信度的仪器 (ICEMAN) 对结果进行分级。90 天时，8 kPa 组的死亡率为 40.4% (724/1792)， 12 kPa 组为 40.9% (733/1793)（风险比，0.99；95% 置信区间 [CI] 0.92-1.07；P = 0.80）。在没有生命支持的情况下，没有观察到存活天数的差异。亚组分析表明，目标为 8 kPa 的 COVID-19 患者在没有生命支持的情况下存活的天数更长 (P = 0.04)（中等可信度），并且癌症患者的死亡率较低 (P = 0.03)，并且在没有生命支持的情况下存活的天数更长 (P = 0.02)。目标为 12 kPa 的患者（可信度低）。这项研究表明，与 8-12 kPa 的 PaO2 目标相比，90 天内死亡率或没有生命支持的存活天数没有总体差异。亚组分析表明，COVID-19（中等可信度）和癌症（低可信度）患者存在 HTE。© 2024。作者。

Optimal oxygenation targets for patients with acute hypoxemic respiratory failure in the intensive care unit (ICU) are not clearly defined due to substantial variability in design of previous trials. This study aimed to perform a pre-specified individual patient data meta-analysis of the Handling Oxygenation Targets in the ICU (HOT-ICU) and the Handling Oxygenation Targets in coronavirus disease 2019 (COVID-19) (HOT-COVID) trials to compare targeting a partial pressure of arterial oxygen (PaO2) of 8-12 kPa in adult ICU patients, assessing both benefits and harms.We assessed 90-day all-cause mortality and days alive without life support in 90 days using a generalised mixed model. Heterogeneity of treatment effects (HTE) was evaluated in 14 subgroups, and results graded using the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN).At 90 days, mortality was 40.4% (724/1792) in the 8 kPa group and 40.9% (733/1793) in the 12 kPa group (risk ratio, 0.99; 95% confidence interval [CI] 0.92-1.07; P = 0.80). No difference was observed in number of days alive without life support. Subgroup analyses indicated more days alive without life support in COVID-19 patients targeting 8 kPa (P = 0.04) (moderate credibility), and lower mortality (P = 0.03) and more days alive without life support (P = 0.02) in cancer-patients targeting 12 kPa (low credibility).This study reported no overall differences comparing a PaO2 target of 8-12 kPa on mortality or days alive without life support in 90 days. Subgroup analyses suggested HTE in patients with COVID-19 (moderate credibility) and cancer (low credibility).© 2024. The Author(s).