We have been concerned about hyperoxaemia for a long time. Numerous studies have documented how supranormal O2-concentrations are harmfull in critical illness. Unfortunately, as far as I can tell anyway, ICU practice hasn’t changed much. We deal with hypoxia straight away, but otherwise we leave our patients marinating in reactive oxygen species for substantial periods of time before someone thinks to reduce FiO2. Maybe a paper published in JAMA will make us pay more attention.
The paper describes the Italian Oxygen-ICU trial, a single-center, open-label trial comparing n=434 adult patients randomly assigned to either conservative (SaO2 94-98% or PaO2 70-100 mmHg) or liberal (SaO2 97-100% or PaO2 values up to 150 mmHg) O2-treatment. The primary outcome was ICU mortality. Secondary outcomes were organ failure and infection.
ICU mortality dropped from 20,2% in the liberal group to 11,6% in the conservative O2 group….
Unfortunately the trial was terminated prematurely (not reaching the required sample size of n=660) because of, of all things, an earthquake.
Still, powerful stuff.
Paper lives here: