Year: 2020
Type: article
Abstract: BACKGROUNDIn patients with acute respiratory distress syndrome (ARDS), the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network recommends a target partial pressure of arterial oxygen (Pao 2 ) between 55 and 80 mm Hg.Prospective validation of this range in patients with ARDS is lacking.We hypothesized that targeting the lower limit of this range would improve outcomes in patients with ARDS. METHODSIn this multicenter, randomized trial, we assigned patients with ARDS to receive either conservative oxygen therapy (target Pao 2 , 55 to 70 mm Hg; oxygen saturation as measured by pulse oximetry [Spo 2 ], 88 to 92%) or liberal oxygen therapy (target Pao 2 , 90 to 105 mm Hg; Spo 2 , ≥96%) for 7 days.The same mechanical-ventilation strategies were used in both groups.The primary outcome was death from any cause at 28 days. RESULTSAfter the enrollment of 205 patients, the trial was prematurely stopped by the data and safety monitoring board because of safety concerns and a low likelihood of a significant difference between the two groups in the primary outcome.Four patients who did not meet the eligibility criteria were excluded.At day 28, a total of 34 of 99 patients (34.3%) in the conservative-oxygen group and 27 of 102 patients (26.5%) in the liberal-oxygen group had died (difference, 7.8 percentage points; 95% confidence interval [CI], -4.8 to 20.6).At day 90, 44.4% of the patients in the conservative-oxygen group and 30.4% of the patients in the liberal-oxygen group had died (difference, 14.0 percentage points; 95% CI, 0.7 to 27.2).Five mesenteric ischemic events occurred in the conservative-oxygen group. CONCLUSIONSAmong patients with ARDS, early exposure to a conservative-oxygenation strategy with a Pao 2 between 55 and 70 mm Hg did not increase survival at 28 days.
Source: New England Journal of Medicine
Authors: Loic Barrot, Pierre Asfar, Frederic Mauny, Hadrien Winiszewski, Florent Montini, Julio Badie, Jean-Pierre Quenot, Sebastien Pili-Floury, Belaid Bouhemad, Guillaume Louis, Bertrand Souweine, Olivier Collange, Julien Pottecher, Bruno Levy, Marc Puyraveau, Lucie Vettoretti, Jean-Michel Constantin, Gilles Capellier
Institutions: Inserm, Centre Hospitalier Universitaire de Besançon, Université d'Angers, Université de Franche-Comté, L'Hôpital Nord Franche-Comté, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpitaux Universitaires de Strasbourg, Centre Hospitalier Régional et Universitaire de Nancy, Monash University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3011047309