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Title: Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy.
Austin Authors: Young, Paul;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
Affiliation: Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
Intensive Care
Medical Research Institute of New Zealand, Wellington, New Zealand
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
Division of Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
University of Melbourne, Parkville, VIC, Australia
Intensive Care Unit, Wellington Hospital, Private Bag 7902, Wellington, New Zealand
Medical Research Institute of New Zealand, Wellington, New Zealand
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
Intensive Care Unit, John Hunter Hospital, New Lambton Heights, NSW, Australia
Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
Medical Research Institute of New Zealand, Wellington, New Zealand
Intensive Care Unit, Hawkes Bay Hospital, Hastings, New Zealand
Issue Date: Dec-2020 2020-08-18
Publication information: Intensive Care Medicine 2020; 46(12): 2411-2422
Abstract: Liberal use of oxygen may contribute to secondary brain injury in patients with hypoxic-ischaemic encephalopathy (HIE). However, there are limited data on the effect of different oxygen regimens on survival and neurological disability in HIE patients. We undertook a post-hoc analysis of the 166 patients with suspected HIE enrolled in a trial comparing conservative oxygen therapy with usual oxygen therapy in 1000 mechanically ventilated ICU patients. The primary endpoint for the current analysis was death or unfavourable neurological outcome at day 180. Key secondary outcomes were day 180 mortality, and cause-specific mortality. Patients with HIE allocated to conservative oxygen spent less time in the ICU with an SpO2 ≥ 97% (26 h [interquartile range (IQR) 13-45 vs. 35 h [IQR 19-70], absolute difference, 9 h; 95% CI - 21.4 to 3.4). A total of 43 of 78 patients (55.1%) assigned to conservative oxygen and 49 of 72 patients (68.1%) assigned to usual oxygen died or had an unfavourable neurological outcome at day 180; odds ratio 0.58; 95% CI 0.3-1.12; P = 0.1 adjusted odds ratio 0.54; 95% CI 0.23-1.26; P = 0.15. A total of 37 of 86 patients (43%) assigned to conservative oxygen and 46 of 78 (59%) assigned to usual oxygen had died by day 180; odds ratio 0.53; 95% CI 0.28-0.98; P = 0.04; adjusted odds ratio 0.56; 95% CI 0.25-1.23; P = 0.15. Cause-specific mortality was similar by treatment group. Conservative oxygen therapy was not associated with a statistically significant reduction in death or unfavourable neurological outcomes at day 180. The potential for important benefit or harm from conservative oxygen therapy in HIE patients is not excluded by these data.
DOI: 10.1007/s00134-020-06196-y
ORCID: 0000-0002-3428-3083
Journal: Intensive Care Medicine
PubMed URL: 32809136
Type: Journal Article
Subjects: Cardiac arrest
Critical care
Hypoxic ischemic encephalopathy
Intensive care medicine
Oxygen therapy
Randomized controlled trial
Appears in Collections:Journal articles

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