Liberal Versus Restrictive Oxygenation Targets in Acute Heart Failure-A Protocol for a Systematic Review With...

Supplemental oxygen therapy has been used for more than a century and is a routine treatment for patients with cardiopulmonary symptoms, including those with acute heart failure (AHF). Despite oxygen being one of the first interventions initiated in the emergency setting, the optimal oxygen saturation target and treatment strategy in AHF remain unclear. Given the clinical uncertainty, we will perform a systematic review comparing liberal and restrictive oxygenation targets in acute heart failure. We hypothesize that restrictive oxygen strategies are associated with reduced mortality and fewer serious adverse events.

We have used the recommendations of The Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols to develop this protocol. All randomized clinical trials assessing restrictive versus liberal oxygenation targets in AHF will be included in our analysis. We will systematically search all relevant major medical databases, including MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as clinical trial registries. We will assess the risk of bias using the Cochrane Risk of Bias tool. Included trials will be assessed and classified as low risk of bias or high risk of bias. We will perform traditional meta-analysis and trial sequential analysis of all outcomes and evaluate the certainty of evidence using the Grading of Recommendations Assessment. This review is registered in the Prospero database (CRD420251046982).

In this protocol we have defined the methodology we will use in a systematic review with meta-analysis where we aim to provide reliable evidence regarding restrictive versus liberal oxygenation targets in AHF. We hope this review will aid clinicians in optimal oxygen treatment strategies in patients with AHF.