UMEM Educational Pearls

Category: Critical Care

Title: Oxygen-ICU

Posted: 10/11/2016 by Mike Winters, MD (Updated: 4/25/2024)
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Question

Oxygen-ICU Trial

Recent observational trials have demonstrated an association between hyperoxia and worse outcomes in select critically ill patient populations.
The Oxygen-ICU Trial was just published online in JAMA, and was an RCT to assess whether a conservative protocol for oxygen supplementation could improve outcomes in critically ill ICU patients compared with usual care.
A total of 236 patients were randomized to the conservative oxgyen group (PaO2 target 70-100 mm Hg, SpO2 94-98%), whereas 244 were randomized to the usual care group (PaO2 up to 150 mm Hg, SpO2 97-100%).
The results demonstrated that ICU mortality was lower in patients treated witih a conservative oxygen strategy, with an absolute risk reduction of 8.6%.
Take Home Point: Be careful with the tiration of oxygen therapy and avoid hyperoxia in many of your critically ill patients.

Answer

A few additional important points about this particular study should be emphasized:

Single center in Italy
Patients were adult patients > 18 years of age who had an expected ICU LOS of at least 72 hours.
The trial was stopped early before the planned 660 patients were enrolled. The authors cite that the hospital sustained significant damage from an earthquake during the study. As a result, recruitment slowed and the authors felt that too much time was passing where changes in standard care may affect study outcomes.
They used a modified intention to treat analysis, which was confirmed when they completed a true intention to treat analysis.

References

Girardis M, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit. The Oxygen-ICU randomized trial. JAMA 2016. [epub ahead of print]