Early Restrictive vs Liberal Oxygen for Trauma Patients: The TRAUMOX2 Randomized Clinical Trial

Area of Science:

• Emergency Medicine
• Intensive Care Medicine
• Trauma Surgery

Background:

• Liberal oxygen administration is common in severe trauma but linked to adverse outcomes.
• Evidence is needed to guide optimal oxygen strategies in trauma resuscitation.

Purpose of the Study:

• To compare the efficacy of a restrictive versus liberal oxygen strategy in reducing death and/or major respiratory complications in adult trauma patients.

Main Methods:

• A multicenter randomized controlled trial involving 1979 adult trauma patients.
• Patients received either a restrictive (SpO2 target 94%) or liberal oxygen strategy for 8 hours.
• Primary outcome was a composite of death and/or major respiratory complications within 30 days.

Main Results:

• No significant difference in the composite outcome between restrictive (16.1%) and liberal (16.7%) oxygen groups (OR, 1.01; P=.94).
• Individual components of the composite outcome also showed no significant differences.
• Atelectasis was less frequent in the restrictive oxygen group (27.6% vs 34.7%).

Conclusions:

• An early restrictive oxygen strategy did not significantly reduce death or major respiratory complications in adult trauma patients.
• The findings do not support a change from current liberal oxygen administration practices in the prehospital or early hospital setting.
• Further research may explore nuanced oxygen titration based on individual patient physiology.