- Title
- Conservative versus liberal oxygenation targets for mechanically ventilated patients: a pilot multicenter randomized controlled trial
- Creator
- Panwar, Rakshit; Hardie, Miranda; Bellomo, Rinaldo; Barrot, Loïc; Eastwood, Glenn M.; Young, Paul J.; Capellier, Gilles; Harrigan, Peter W. J.; Bailey, Michael
- Relation
- American Journal of Respiratory and Critical Care Medicine Vol. 193, Issue 1, p. 43-51
- Publisher Link
- http://dx.doi.org/10.1164/rccm.201505-1019OC
- Publisher
- American Thoracic Society
- Resource Type
- journal article
- Date
- 2016
- Description
- 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). MeasurementsandMainResults:Themean 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.
- Identifier
- http://hdl.handle.net/1959.13/1343628
- Identifier
- uon:29228
- Identifier
- ISSN:1073-449X
- Language
- eng
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