UMEM Educational Pearls

Category: Critical Care

Title: Conservative oxygenation during mechanical ventilation

Keywords: conservative oxygenation (PubMed Search)

Posted: 11/26/2019 by Quincy Tran, MD (Updated: 2/19/2020)
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  • Patients: mechanical ventilation in the ICU. Randomization of 1000 patients.
  • Intervention: conservative oxygen therapy, if spO2 reached 97%, then FiO2 was lowered to 0.21
  • Comparison: no specific limits for FiO2 or SpO2.
  • Outcome: number of ventilator-free days at 28 days after randomization.

Study Results:

  • 484 conservative-oxygen group vs  481 to the usual oxygen group
  • Comparing to the conservative-oxygen group had:
  • more time at FiO2 21 (29 hours vs. 28 hours),
  • less time with SpO2 > 97% (27 hours vs. 49 hours)
  • Similar ventilator-free days: 21 days vs. 22 days.

Discussion:

This study’s results differed from previous single center study (Girardis JAMA 2016) or meta analysis (Chu DK, Lancer 2018), which showed mortality benefit in patients with conservative oxygen (Girardis & Chu) and more ventilator-free days (Girardis).

Conclusion: Conservative oxygen did not significantly affect the ventilator free days of mechanically ventilated patients.

References

Reference:

1. ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group, Mackle D, Bellomo R, Bailey M, Beasley R, Deane A, Eastwood G, Finfer S, Freebairn R, King V, Linke N, Litton E, McArthur C, McGuinness S, Panwar R, Young P.

Conservative Oxygen Therapy during Mechanical Ventilation in the ICU. N Engl J Med. 2019 Oct 14. doi: 10.1056/NEJMoa1903297. [Epub ahead of print]

2. Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis.

Lancet 2018; 391: 1693-705.

3. Girardis M, Busani S, Damiani E, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the Oxygen-ICU. randomized clinical trial.

JAMA 2016; 316: 1583-9.