Please use this identifier to cite or link to this item:
Title: Conservative Oxygen Therapy during Mechanical Ventilation in the ICU.
Austin Authors: Mackle, Diane;Bellomo, Rinaldo ;Bailey, Michael;Beasley, Richard;Deane, Adam;Eastwood, Glenn M ;Finfer, Simon;Freebairn, Ross;King, Victoria;Linke, Natalie;Litton, Edward;McArthur, Colin;McGuinness, Shay;Panwar, Rakshit;Young, Paul
Institutional Author: ICU-ROX Investigators
Australian and New Zealand Intensive Care Society Clinical Trials Group
Affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
Division of Critical Care and Trauma, George Institute for Global Health, Sydney, NSW, Australia
Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
Intensive Care Unit, John Hunter Hospital, New Lambton Heights, NSW, Australia
Medical Research Institute of New Zealand, Wellington, New Zealand
Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
Intensive Care Unit, Hawkes Bay Hospital, Hastings, New Zealand
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
University of Melbourne, Parkville, Victoria, Australia
Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
Issue Date: 2020 2019-10-14
Publication information: The New England Journal of Medicine 2020; 382(11): 989-998
Abstract: Patients who are undergoing mechanical ventilation in the intensive care unit (ICU) often receive a high fraction of inspired oxygen (Fio2) and have a high arterial oxygen tension. The conservative use of oxygen may reduce oxygen exposure, diminish lung and systemic oxidative injury, and thereby increase the number of ventilator-free days (days alive and free from mechanical ventilation). We randomly assigned 1000 adult patients who were anticipated to require mechanical ventilation beyond the day after recruitment in the ICU to receive conservative or usual oxygen therapy. In the two groups, the default lower limit for oxygen saturation as measured by pulse oximetry (Spo2) was 90%. In the conservative-oxygen group, the upper limit of the Spo2 alarm was set to sound when the level reached 97%, and the Fio2 was decreased to 0.21 if the Spo2 was above the acceptable lower limit. In the usual-oxygen group, there were no specific measures limiting the Fio2 or the Spo2. The primary outcome was the number of ventilator-free days from randomization until day 28. The number of ventilator-free days did not differ significantly between the conservative-oxygen group and the usual-oxygen group, with a median duration of 21.3 days (interquartile range, 0 to 26.3) and 22.1 days (interquartile range, 0 to 26.2), respectively, for an absolute difference of -0.3 days (95% confidence interval [CI], -2.1 to 1.6; Pā€‰=ā€‰0.80). The conservative-oxygen group spent more time in the ICU with an Fio2 of 0.21 than the usual-oxygen group, with a median duration of 29 hours (interquartile range, 5 to 78) and 1 hour (interquartile range, 0 to 17), respectively (absolute difference, 28 hours; 95% CI, 22 to 34); the conservative-oxygen group spent less time with an Spo2 exceeding 96%, with a duration of 27 hours (interquartile range, 11 to 63.5) and 49 hours (interquartile range, 22 to 112), respectively (absolute difference, 22 hours; 95% CI, 14 to 30). At 180 days, mortality was 35.7% in the conservative-oxygen group and 34.5% in the usual-oxygen group, for an unadjusted odds ratio of 1.05 (95% CI, 0.81 to 1.37). In adults undergoing mechanical ventilation in the ICU, the use of conservative oxygen therapy, as compared with usual oxygen therapy, did not significantly affect the number of ventilator-free days. (Funded by the New Zealand Health Research Council; ICU-ROX Australian and New Zealand Clinical Trials Registry number, ACTRN12615000957594.).
DOI: 10.1056/NEJMoa1903297
ORCID: 0000-0003-0337-406X
PubMed URL: 31613432
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Dec 7, 2022

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.