Conservative versus Liberal Oxygenation Targets for Mechanically Ventilated Patients. A Pilot Multicenter Randomized Controlled Trial
Abstract
Rationale: There are no randomized controlled trials comparing different oxygenation targets for intensive care unit (ICU) patients. Objectives: To determine whether a conservative oxygenation strategy is a feasible alternative to a liberal oxygenation strategy among ICU patients requiring invasive mechanical ventilation (IMV). Methods: At four multidisciplinary ICUs, 103 adult patients deemed likely to require IMV for greater than or equal to 24 hours were randomly allocated to either a conservative oxygenation strategy with target oxygen saturation as measured by pulse oximetry (SpO2) of 88–92% (n = 52) or a liberal oxygenation strategy with target SpO2 of greater than or equal to 96% (n = 51). Measurements and Main Results: The mean area under the curve and 95% confidence interval (CI) for SpO2 (93.4% [92.9–93.9%] vs. 97% [96.5–97.5%]), SaO2 (93.5% [93.1–94%] vs. 96.8% [96.3–97.3%]), PaO2 (70 [68–73] mm Hg vs. 92 [89–96] mm Hg), and FiO2 (0.26 [0.25–0.28] vs. 0.36 [0.34–0.39) in the conservative versus liberal oxygenation arm were significantly different (P < 0.0001 for all). There were no significant between-group differences in any measures of new organ dysfunction, or ICU or 90-day mortality. The percentage time spent with SpO2 less than 88% in conservative versus liberal arm was 1% versus 0.3% (P = 0.03), and percentage time spent with SpO2 greater than 98% in conservative versus liberal arm was 4% versus 22% (P < 0.001). The adjusted hazard ratio for 90-day mortality in the conservative arm was 0.77 (95% CI, 0.40–1.50; P = 0.44) overall and 0.49 (95% CI, 0.20–1.17; P = 0.10) in the prespecified subgroup of patients with a baseline PaO2/FiO2 less than 300. Conclusions: Our study supports the feasibility of a conservative oxygenation strategy in patients receiving IMV. Larger randomized controlled trials of this intervention appear justified. Clinical trial registered with Australian New Zealand Clinical Trials Registry (ACTRN 12613000505707)
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The evidence for the use of conservative oxygen targets and therapy in patients with sepsis is limited, with three randomised trials in the critically ill population.
“The evidence for the use of conservative oxygen targets (generally defined as PaO2 55–70 mmHg; SpO2 88–92%) and therapy in patients with sepsis is limited, with three randomised trials in the critically ill population [404–406].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [406]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
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- Authors
- Panwar, R., Hardie, M., Bellomo, R., Barrot, L., Eastwood, G. M., Young, P. J., Capellier, G., Harrigan, P. W. J., & Bailey, M.
- Affiliations
- John Hunter Hospital (AU)
- The University of Melbourne (AU)
- Centre Hospitalier Universitaire de Besançon (FR)
- Wellington Hospital (NZ)
- Monash University (AU)
- Corresponding author
- Panwar, Rakshit
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-01-01
- Volume
- 193
- Issue
- 1
- Pages
- 43-51
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W1928918188
- Cited by
- 287
- References
- 55
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 17 · 2023: 24 · 2022: 36 · 2021: 54 · 2020: 20 · 2019: 29 · 2018: 31 · 2017: 29 · 2016: 23 · 2015: 2
- FWCI
- 22.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- Intensive Care Foundation
- University Hospital Besançon
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- oxygen saturation targets, invasive mechanical ventilation, intensive care unit patients, oxygen therapy, 90-day mortality, organ dysfunction, fraction of inspired oxygen, PaO2, pulse oximetry, ventilator-associated pneumonia, acute kidney injury, acute respiratory distress syndrome, acute heart failure, acute stroke, acute liver failure
- MeSH terms
- Female, Humans, Intensive Care Units, Male, Middle Aged, Oximetry, Oxygen, Oxygen Inhalation Therapy, Pilot Projects, Respiration, Artificial
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