Ventilation & weaning · Oxygenation targets in the ventilated patient
Oxygen-Saturation Targets for Critically Ill Adults Receiving Mechanical Ventilation
| Design | Pragmatic, cluster-crossover randomised trial with three arms |
|---|---|
| Treatment | Lower SpO2 target of 90%, or intermediate target of 94% |
| Control | Higher SpO2 target of 98% |
| Population | 2541 critically ill adults receiving invasive mechanical ventilation |
| Follow-up | 28 days |
| Primary endpoint | Ventilator-free days to day 28 |
| Result | Median ventilator-free days 20 (IQR 0 to 25) with the lower target, 21 (0 to 25) with the intermediate target and 21 (0 to 26) with the higher target (p=0.81). In-hospital death by day 28 did not differ meaningfully between groups. |
| Secondary endpoints | In-hospital mortality at day 28 |
Among critically ill adults receiving invasive mechanical ventilation, the number of ventilator-free days did not differ among groups in which a lower, intermediate, or higher Spo2 target was used.
The trial authors, in the published abstract
Three targets, one answer: within the 90 to 98% range the number does not matter. Together with ICU-ROX and the much larger UK-ROX this is now settled, and attention has shifted to the extremes — where LOCO2 showed that going below this range does cause harm.
Semler MW, Casey JD, Lloyd BD, et al. Oxygen-Saturation Targets for Critically Ill Adults Receiving Mechanical Ventilation. N Engl J Med 2022 Nov 10;387(19):1759-1769.