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Am J Respir Crit Care Med. 2016 Jan 1;193(1):43-51. doi: 10.1164/rccm.201505-1019OC.

Conservative versus Liberal Oxygenation Targets for Mechanically Ventilated Patients. A Pilot Multicenter Randomized Controlled Trial.

Author information

1
1 Intensive Care Unit, John Hunter Hospital, Newcastle, Australia.
2
2 School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
3
3 Department of Intensive Care, Austin Hospital, The University of Melbourne, Melbourne, Australia.
4
4 Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
5
5 Critical Care Unit, University Hospital Besançon and University of Franche-Comté, Besançon, France.
6
6 Intensive Care Unit, Wellington Hospital, Wellington, New Zealand; and.
7
7 Medical Research Institute of New Zealand, Wellington, New Zealand.

Abstract

RATIONALE:

There are no randomized controlled trials comparing different oxygenation targets for intensive care unit (ICU) patients.

OBJECTIVES:

To determine whether a conservative oxygenation strategy is a feasible alternative to a liberal oxygenation strategy among ICU patients requiring invasive mechanical ventilation (IMV).

METHODS:

At four multidisciplinary ICUs, 103 adult patients deemed likely to require IMV for greater than or equal to 24 hours were randomly allocated to either a conservative oxygenation strategy with target oxygen saturation as measured by pulse oximetry (SpO2) of 88-92% (n = 52) or a liberal oxygenation strategy with target SpO2 of greater than or equal to 96% (n = 51).

MEASUREMENTS AND MAIN RESULTS:

The mean area under the curve and 95% confidence interval (CI) for SpO2 (93.4% [92.9-93.9%] vs. 97% [96.5-97.5%]), SaO2 (93.5% [93.1-94%] vs. 96.8% [96.3-97.3%]), PaO2 (70 [68-73] mm Hg vs. 92 [89-96] mm Hg), and FiO2 (0.26 [0.25-0.28] vs. 0.36 [0.34-0.39) in the conservative versus liberal oxygenation arm were significantly different (P < 0.0001 for all). There were no significant between-group differences in any measures of new organ dysfunction, or ICU or 90-day mortality. The percentage time spent with SpO2 less than 88% in conservative versus liberal arm was 1% versus 0.3% (P = 0.03), and percentage time spent with SpO2 greater than 98% in conservative versus liberal arm was 4% versus 22% (P < 0.001). The adjusted hazard ratio for 90-day mortality in the conservative arm was 0.77 (95% CI, 0.40-1.50; P = 0.44) overall and 0.49 (95% CI, 0.20-1.17; P = 0.10) in the prespecified subgroup of patients with a baseline PaO2/FiO2 less than 300.

CONCLUSIONS:

Our study supports the feasibility of a conservative oxygenation strategy in patients receiving IMV. Larger randomized controlled trials of this intervention appear justified. Clinical trial registered with Australian New Zealand Clinical Trials Registry (ACTRN 12613000505707).

KEYWORDS:

critical illness; intensive care; mechanical ventilation; oxygen inhalation therapy; targets

PMID:
26334785
DOI:
10.1164/rccm.201505-1019OC
[Indexed for MEDLINE]

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