Oxygen-ICU Trial

• Recent observational trials have demonstrated an association between hyperoxia and worse outcomes in select critically ill patient populations.
• The Oxygen-ICU Trial was just published online in JAMA, and was an RCT to assess whether a conservative protocol for oxygen supplementation could improve outcomes in critically ill ICU patients compared with usual care.
• A total of 236 patients were randomized to the conservative oxgyen group (PaO2 target 70-100 mm Hg, SpO2 94-98%), whereas 244 were randomized to the usual care group (PaO2 up to 150 mm Hg, SpO2 97-100%).
• The results demonstrated that ICU mortality was lower in patients treated witih a conservative oxygen strategy, with an absolute risk reduction of 8.6%.
• Take Home Point: Be careful with the tiration of oxygen therapy and avoid hyperoxia in many of your critically ill patients.

Additional Information

A few additional important points about this particular study should be emphasized:

• Single center in Italy
• Patients were adult patients > 18 years of age who had an expected ICU LOS of at least 72 hours.
• The trial was stopped early before the planned 660 patients were enrolled.  The authors cite that the hospital sustained significant damage from an earthquake during the study.  As a result, recruitment slowed and the authors felt that too much time was passing where changes in standard care may affect study outcomes.
• They used a modified intention to treat analysis, which was confirmed when they completed a true intention to treat analysis.

References

Girardis M, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit. The Oxygen-ICU randomized trial. JAMA 2016. [epub ahead of print]