Association between oxygen saturation ranges and mortality among mechanically ventilated sepsis-associated ARDS...

The SpO₂ range associated with the best survival outcomes for acute respiratory distress syndrome (ARDS), particularly in sepsis-related cases, remains unclear. This study aimed to explore oxygenation range for patients with sepsis and ARDS during mechanical ventilation.

We analyzed 2951 ICU patients with sepsis and ARDS requiring mechanical ventilation. Using restricted cubic splines (RCS) and generalized additive models (GAM), we identified optimal oxygenation ranges, which were further cross-replicated across independent ICU datasets via logistic regression, propensity score matching, IPW, and double robustness analysis. The primary outcome was 28-day all-cause mortality.

In this cohort, the range of oxygen saturation (SpO₂) with 93%-99% was associated with the lowest 28-day mortality in patients with sepsis and ARDS, as determined by RCS and GAMs. These findings were verified via multivariate logistic regression, propensity score matching, IPW, and double-robust adjustment incorporating all available covariates. This range SpO₂ window remained consistent across mild, moderate and severe ARDS subgroups. Patients with SpO₂ < 93% had higher SOFA, APACHE II and SAPS II scores. Infection source did not significantly modify the SpO₂-mortality association.

SpO₂ ranging from 93% to 99% was independently associated with reduced 28-day all-cause mortality in mechanically ventilated patients with sepsis-related ARDS in this retrospective cohort.