Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome
Open accessAbstract
BACKGROUND: ) between 55 and 80 mm Hg. Prospective validation of this range in patients with ARDS is lacking. We hypothesized that targeting the lower limit of this range would improve outcomes in patients with ARDS. METHODS: , ≥96%) for 7 days. The same mechanical-ventilation strategies were used in both groups. The primary outcome was death from any cause at 28 days. RESULTS: After the enrollment of 205 patients, the trial was prematurely stopped by the data and safety monitoring board because of safety concerns and a low likelihood of a significant difference between the two groups in the primary outcome. Four patients who did not meet the eligibility criteria were excluded. At day 28, a total of 34 of 99 patients (34.3%) in the conservative-oxygen group and 27 of 102 patients (26.5%) in the liberal-oxygen group had died (difference, 7.8 percentage points; 95% confidence interval [CI], -4.8 to 20.6). At day 90, 44.4% of the patients in the conservative-oxygen group and 30.4% of the patients in the liberal-oxygen group had died (difference, 14.0 percentage points; 95% CI, 0.7 to 27.2). Five mesenteric ischemic events occurred in the conservative-oxygen group. CONCLUSIONS: ClinicalTrials.gov number, NCT02713451.).
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A network meta-analysis of 14 RCTs of patients with sepsis showed in an indirect comparison that balanced crystalloids were associated with decreased mortality compared to saline.
“Subsequently, a network meta-analysis of 14 RCTs of patients with sepsis showed in an indirect comparison that balanced crystalloids were associated with decreased mortality, compared to saline (331).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [331]
The Discussion (p. 8) describes a randomized trial of oxygen targets in patients with ARDS, not a network meta-analysis of fluids in sepsis. Searches for balanced crystalloids, saline, 14 trials, and an indirect mortality comparison found no passage addressing the attributed finding. (LLM, conf=0.78)
Experimental — accuracy not yet measuredA network meta-analysis of patients with sepsis or septic shock demonstrated a higher risk of death (OR, 1.1; 95% CI, 0.99-1.30) and need for RRT (OR, 1.39; 95% CI, 1.17-1.66) with starches in direct comparison with crystalloids.
“A network meta-analysis of patients with sepsis or septic shock also demonstrated a higher risk of death (OR, 1.1; 95% CI, 0.99-1.30)and need for RRT (OR, 1.39; 95% CI, 1.17-1.66) (331)with starches in a direct comparison with crystalloids.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [331]
The Trial Outcomes (p. 3) and Discussion (p. 8) concern conservative versus liberal oxygen therapy in patients with ARDS, not a comparison of starches and crystalloids. Searches for the fluid comparison, network meta-analysis, RRT, and the reported odds ratios found no passage addressing the claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn an indirect comparison, a four-node network meta-analysis in patients with sepsis showed no clear effect on mortality with gelatin compared with crystalloids (OR, 1.24; 95% CrI 0.61-2.55).
“In an indirect comparison, a four-node network meta-analysis conducted in patients with sepsis, showed no clear effect on mortality when compared with crystalloids (OR, 1.24; 95% credible interval [CrI] 0.61-2.55)(331).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [331]
The Results (p. 1) compare mortality under conservative and liberal oxygen therapy in patients with ARDS, not gelatin and crystalloids in patients with sepsis. Searches for gelatin, crystalloids, and the claimed four-node network meta-analysis found no passage reporting the stated odds ratio or credible interval. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe LOCO-2 study was terminated early by the data safety and monitoring board and reported no difference in 28-day survival in ARDS patients managed with a conservative oxygenation strategy.
“The LOCO-2 study was terminated early by the data safety and monitoring board and reported no difference in 28-day survival in ARDS patients managed with a conservative oxygenation strategy [409].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [409]
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- Authors
- Barrot, L., Asfar, P., Mauny, F., Winiszewski, H., Montini, F., Badie, J., Quenot, J.-P., Pili-Floury, S., Bouhemad, B., Louis, G., Souweine, B., Collange, O., Pottecher, J., Levy, B., Puyraveau, M., Vettoretti, L., Constantin, J.-M., & Capellier, G.
- Affiliations
- From the Medical Intensive Care Unit (L.B., H.W., L.V., G.C.), the Anesthesia and Intensive Care Unit (L.B., S.P.-F.), Unité de Méthodologie, INSERM Clinical Investigation Center 1431, University Hospital (F. Mauny, M.P.), and Research Unit EA3920, Université de Franche Comté (L.B., H.W. S.P.-F., G.C.), Besançon, the Medical Intensive Care Unit, University Hospital of Angers, Angers (P.A.), the Intensive Care Unit, General Hospital of Avignon, Avignon (F. Montini), the Intensive Care Unit, General...
- Inserm (FR)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-03-12
- Volume
- 382
- Issue
- 11
- Pages
- 999-1008
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W3011047309
- Cited by
- 467
- References
- 24
- Citations by year
- 2026: 35 · 2025: 53 · 2024: 55 · 2023: 60 · 2022: 105 · 2021: 103 · 2020: 56
- FWCI
- 45.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- French Health Ministry Programme Hospitalier de Recherche Clinique Interrégional 2015
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- acute respiratory distress syndrome, oxygen therapy, oxygen saturation targets, 28-day mortality, 90-day mortality, mesenteric ischemia, mechanical ventilation
- MeSH terms
- Conservative Treatment, Adult, Aged, Female, Humans, Male, Middle Aged, Oxygen, Oxygen Inhalation Therapy, Respiration, Artificial, Respiratory Distress Syndrome, Time Factors, Survival Analysis, Treatment Outcome
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