Conservative oxygen therapy in mechanically ventilated patients: A pilot before-and-after trial

Satoshi Suzuki, Glenn M. Eastwood, Neil J. Glassford, Leah Peck, Helen Young, Mercedes Garcia-Alvarez, Antoine G. Schneider, Rinaldo Bellomo

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: To assess the feasibility and safety of a conservative approach to oxygen therapy in mechanically ventilated ICU patients. DESIGN: Pilot prospective before-and-after study. SETTING: A 22-bed multidisciplinary ICU of a tertiary care hospital in Australia. PATIENTS: A total of 105 adult (18 years old or older) patients required mechanical ventilation for more than 48 hours: 51 patients during the "conventional" before period and 54 after a change to "conservative" oxygen therapy. INTERVENTIONS: Implementation of a conservative approach to oxygen therapy (target SpO2 of 90-92%). MEASUREMENTS AND MAIN RESULTS: We collected 3,169 datasets on 799 mechanical ventilation days. During conservative oxygen therapy the median time-weighted average SpO2 on mechanical ventilation was 95.5% (interquartile range, 94.0-97.3) versus 98.4% (97.3-99.1) (p <0.001) during conventional therapy. The median PaO2 was 83 torr (71-94) versus 107 torr (94-131) (p <0.001) with a change to a median FIO2 of 0.27 (0.24-0.30) versus 0.40 (0.35-0.44) (p <0.001). Conservative oxygen therapy decreased the median total amount of oxygen delivered during mechanical ventilation by about two thirds (15,580 L [8,263-29,351 L] vs 5,122 L [1,837-10,499 L]; p <0.001). The evolution of the PaO2/FIO 2 ratio was similar during the two periods, and there were no difference in any other biochemical or clinical outcomes. CONCLUSIONS: Conservative oxygen therapy in mechanically ventilated ICU patients was feasible and free of adverse biochemical, physiological, or clinical outcomes while allowing a marked decrease in excess oxygen exposure. Our study supports the safety and feasibility of future pilot randomized controlled trials of conventional compared with conservative oxygen therapy.

Original languageEnglish
Pages (from-to)1414-1422
Number of pages9
JournalCritical Care Medicine
Volume42
Issue number6
DOIs
Publication statusPublished - 2014
Externally publishedYes

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Oxygen
Artificial Respiration
Safety
Conservative Treatment
Tertiary Healthcare
Tertiary Care Centers
Therapeutics
Randomized Controlled Trials

Keywords

  • Anoxia
  • critical illness
  • hyperoxia
  • lactic acid
  • oxygen inhalation therapy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Suzuki, S., Eastwood, G. M., Glassford, N. J., Peck, L., Young, H., Garcia-Alvarez, M., ... Bellomo, R. (2014). Conservative oxygen therapy in mechanically ventilated patients: A pilot before-and-after trial. Critical Care Medicine, 42(6), 1414-1422. https://doi.org/10.1097/CCM.0000000000000219

Conservative oxygen therapy in mechanically ventilated patients : A pilot before-and-after trial. / Suzuki, Satoshi; Eastwood, Glenn M.; Glassford, Neil J.; Peck, Leah; Young, Helen; Garcia-Alvarez, Mercedes; Schneider, Antoine G.; Bellomo, Rinaldo.

In: Critical Care Medicine, Vol. 42, No. 6, 2014, p. 1414-1422.

Research output: Contribution to journalArticle

Suzuki, S, Eastwood, GM, Glassford, NJ, Peck, L, Young, H, Garcia-Alvarez, M, Schneider, AG & Bellomo, R 2014, 'Conservative oxygen therapy in mechanically ventilated patients: A pilot before-and-after trial', Critical Care Medicine, vol. 42, no. 6, pp. 1414-1422. https://doi.org/10.1097/CCM.0000000000000219
Suzuki, Satoshi ; Eastwood, Glenn M. ; Glassford, Neil J. ; Peck, Leah ; Young, Helen ; Garcia-Alvarez, Mercedes ; Schneider, Antoine G. ; Bellomo, Rinaldo. / Conservative oxygen therapy in mechanically ventilated patients : A pilot before-and-after trial. In: Critical Care Medicine. 2014 ; Vol. 42, No. 6. pp. 1414-1422.
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AU - Garcia-Alvarez, Mercedes

AU - Schneider, Antoine G.

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