Ventilation & weaning · Oxygenation targets in the ventilated patient
Conservative Oxygen Therapy during Mechanical Ventilation in the ICU
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Conservative oxygen therapy |
| Control | Usual oxygen therapy |
| Population | 1000 adults undergoing mechanical ventilation in intensive care |
| Follow-up | 180 days |
| Primary endpoint | Ventilator-free days to day 28 |
| Result | Median ventilator-free days 21.3 (IQR 0 to 26.3) with conservative oxygen versus 22.1 (0 to 26.2) with usual oxygen — absolute difference -0.3 days (95% CI -2.1 to 1.6, p=0.80). Mortality at 180 days was 35.7% with conservative oxygen and 34.5% with usual oxygen — unadjusted odds ratio 1.05 (95% CI 0.81 to 1.37). |
| Secondary endpoints | Mortality at 90 and 180 days, ICU and hospital length of stay |
In adults undergoing mechanical ventilation in the ICU, the use of conservative oxygen therapy, as compared with usual oxygen therapy, did not significantly affect the number of ventilator-free days.
The trial authors, in the published abstract
The first of the three large neutral oxygen-target trials, later joined by PILOT and UK-ROX. Its limitation is that usual care in participating units was already fairly conservative, so the separation between arms was modest — a criticism UK-ROX largely answers with scale.
Mackle D, Bellomo R, Bailey M, et al. Conservative Oxygen Therapy during Mechanical Ventilation in the ICU. N Engl J Med 2020 Mar 12;382(11):989-998.