NEJM
October 24, 2022
Oxygen-Saturation Targets for Critically Ill Adults Receiving Mechanical Ventilation
Mazen Kherallah
Summarized by:
What was the research question?
Does the clinical outcome in terms of ventilator-free days differ among different oxygen-saturation targets in patients on mechanical ventilation?
How did they do it?
A pragmatic, unblinded, cluster-randomized, cluster-crossover trial in the emergency department and medical intensive care unit at Vanderbilt University Medical Center in the US.
2541 adult patients who were receiving mechanical ventilation were randomized to receive a lower target for oxygen saturation (90%; goal range, 88 to 92%), an intermediate target (94%; goal range, 92 to 96%), or a higher target (98%; goal range, 96 to 100%).
The primary outcome was ventilator-free days through day 28. The secondary outcome was death by day 28.
What did they find?
There was no significant difference in the median number of ventilator-free days between the lower-target group, intermediate-target group, and higher-target group (20 vs. 21 vs. 21 days, p=0.81).
In-hospital death by day 28 was not significantly different among the three groups (34.8% in the low-target, 34% in the intermediate target, and 33.2% in the high-target group).
There was no significant difference in the incidences of cardiac arrest, arrhythmia, myocardial infarction, stroke, and pneumothorax between the three groups.
Are there any limitations?
A single center study and study results may not be generalizable to other patient population.
Patient population was restricted to medical patients
The study neither confirms nor refutes treatment effects of a magnitude that is plausible
The study is unable to confirm or refute a heterogeneity of treatment effect.
What does it mean?
There was no difference in the number of ventilator-free days among critically ill adults receiving invasive mechanical ventilation when a lower, intermediate, or higher Spo2 target was used. Additionally, there were no differences in the secondary outcomes including 28-day mortality.
The study assures that the is no overt harm from liberal or restrictive oxygen regimen.
No change in clinical practice.