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Targeting different oxygen saturation goals for mechanically ventilated patients does not impact clinical outcomes
Clinical Question
For critically ill adults using mechanical ventilation, does targeting a lower, intermediate, or higher oxygen saturation affect clinical outcomes?
Bottom line
Targeting lower, intermediate, or higher oxygenation levels for critically ill adults using mechanical ventilation does not affect the number of ventilator-free days or the number of deaths in the short term. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Government
Setting: Inpatient (ICU only)
Synopsis
The optimal oxygenation target for critically ill patients is unknown. In this trial, conducted in a single academic center, all patients receiving mechanical ventilation in the emergency department and medical intensive care unit were assigned together to an oxygenation target, either lower (target 90%; range 88%-92%), intermediate (target 94%; range 92%-96%), or higher (target 98%; range 96%-100%). Every 2 months, the target was changed according to a randomly generated sequence, for a total of 36 months and 18 trial periods. Respiratory therapists adjusted the fraction of inspired oxygen to achieve the target oxygen saturation (SpO2) as assessed by continuous pulse oximetry. A total of 2541 patients were analyzed. The study groups had similar baseline characteristics. The median SpO2 values in the 3 groups were 94% in the lower group, 95% in the intermediate group, and 97% in the higher group. For the primary outcome of ventilator-free days through day 28, there was no significant difference detected among the 3 groups. The incidences of death and adverse events at 28 days were also similar. Of note, the median SpO2 value for the lower group actually fell in the range of the intermediate group; therefore, it is possible that sticking to a true lower oxygenation target may impact outcomes, but this study does not answer that question.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
Targeting different oxygen saturation goals for mechanically
Not surprised there were no outcome difference given the minimal differences in SpO2 between the three groups. It would be interesting to know the outcomes of patients with SpO2100 since these would be the only patients at risk for hyperoxia which is the crux of the issue.
O2 saturation - ventilation
As per the reviewer's comments
lower or higher oxygen sat targets in icu pts
doesn't make much difference in outcome
Impact assessment
Very good