Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC): A Randomized Clinical Trial

RATIONALE: Supplemental oxygen is widely administered to ICU patients, but appropriate oxygenation targets remain unclear. OBJECTIVES: This study aimed to determine whether a low-oxygenation strategy would lower 28-day mortality compared with a high-oxygenation strategy. METHODS: This randomized mul...

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Detalles Bibliográficos
Autores principales: van der Wal, L. Imeen, Grim, Chloe C. A., del Prado, Michael R., van Westerloo, David J., Boerma, E. Christiaan, Rijnhart-de Jong, Hilda G., Reidinga, Auke C., Loef, Bert G., van der Heiden, Pim L. J., Sigtermans, Marnix J., Paulus, Frederique, Cornet, Alexander D., Loconte, Maurizio, Schoonderbeek, F. Jeannette, de Keizer, Nicolette F., Bakhshi-Raiez, Ferishta, Le Cessie, Saskia, Serpa Neto, Ary, Pelosi, Paolo, Schultz, Marcus J., Helmerhorst, Hendrik J. F., de Jonge, Evert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Thoracic Society 2023
Materias:
Original Articles
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563190/
https://www.ncbi.nlm.nih.gov/pubmed/37552556
http://dx.doi.org/10.1164/rccm.202303-0560OC
Descripción
Sumario:RATIONALE: Supplemental oxygen is widely administered to ICU patients, but appropriate oxygenation targets remain unclear. OBJECTIVES: This study aimed to determine whether a low-oxygenation strategy would lower 28-day mortality compared with a high-oxygenation strategy. METHODS: This randomized multicenter trial included mechanically ventilated ICU patients with an expected ventilation duration of at least 24 hours. Patients were randomized 1:1 to a low-oxygenation (Pa(O(2)), 55–80 mm Hg; or oxygen saturation as measured by pulse oximetry, 91–94%) or high-oxygenation (Pa(O(2)), 110–150 mm Hg; or oxygen saturation as measured by pulse oximetry, 96–100%) target until ICU discharge or 28 days after randomization, whichever came first. The primary outcome was 28-day mortality. The study was stopped prematurely because of the COVID-19 pandemic when 664 of the planned 1,512 patients were included. MEASUREMENTS AND MAIN RESULTS: Between November 2018 and November 2021, a total of 664 patients were included in the trial: 335 in the low-oxygenation group and 329 in the high-oxygenation group. The median achieved Pa(O(2)) was 75 mm Hg (interquartile range, 70–84) and 115 mm Hg (interquartile range, 100–129) in the low- and high-oxygenation groups, respectively. At Day 28, 129 (38.5%) and 114 (34.7%) patients had died in the low- and high-oxygenation groups, respectively (risk ratio, 1.11; 95% confidence interval, 0.9–1.4; P = 0.30). At least one serious adverse event was reported in 12 (3.6%) and 17 (5.2%) patients in the low- and high-oxygenation groups, respectively. CONCLUSIONS: Among mechanically ventilated ICU patients with an expected mechanical ventilation duration of at least 24 hours, using a low-oxygenation strategy did not result in a reduction of 28-day mortality compared with a high-oxygenation strategy. Clinical trial registered with the National Trial Register and the International Clinical Trials Registry Platform (NTR7376).

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