Effect of Low-Normal vs High-Normal Oxygenation Targets on Organ Dysfunction in Critically Ill Patients: A Randomized...

Area of Science:

• Critical Care Medicine
• Pulmonology
• Nephrology

Background:

• Hyperoxemia in critically ill patients may worsen organ dysfunction.
• Optimal oxygenation targets for patients with Systemic Inflammatory Response Syndrome (SIRS) remain undetermined.

Purpose of the Study:

• To compare the effects of a low-normal Pao2 target versus a high-normal Pao2 target on organ dysfunction in critically ill patients with SIRS.
• To investigate the impact of different oxygenation targets on mechanical ventilation duration, in-hospital mortality, and hypoxemic events.

Main Methods:

• A multicenter randomized clinical trial involving 574 adult patients with SIRS criteria across 4 intensive care units.
• Patients were randomized to either a low-normal Pao2 target (8-12 kPa) or a high-normal Pao2 target (14-18 kPa).
• The primary outcome was SOFARANK, a composite measure of nonrespiratory organ failure over 14 days.

Main Results:

• No statistically significant difference in SOFARANK scores between the low-normal and high-normal Pao2 groups (median difference, 10 points; P=.06).
• Similar rates of mechanical ventilation duration and in-hospital mortality were observed between groups.
• Mild hypoxemic measurements were more frequent in the low-normal Pao2 group (1.9% vs 1.2%).

Conclusions:

• Targeting a low-normal Pao2 in critically ill patients with SIRS did not lead to a statistically significant reduction in organ dysfunction compared to a high-normal target.
• The study may have been underpowered to detect smaller treatment effects.
• Further investigation is warranted to establish optimal oxygenation strategies in this patient population.