Ventilation & weaning · Oxygenation targets in the ventilated patient
Conservative Oxygen Therapy in Mechanically Ventilated Critically Ill Adult Patients
| Design | Pragmatic, multicentre, registry-embedded randomised clinical trial |
|---|---|
| Treatment | Conservative oxygen therapy targeting SpO2 90% |
| Control | Usual oxygen therapy |
| Population | 16500 mechanically ventilated critically ill adults, median age 60, 38.2% female |
| Follow-up | 90 days |
| Primary endpoint | All-cause mortality at 90 days |
| Result | Supplemental oxygen exposure was 29% lower in the conservative group. By 90 days 2908 of 8211 (35.4%) had died in the conservative group versus 2858 of 8183 (34.9%) with usual care — adjusted risk difference 0.7 percentage points (95% CI -0.7 to 2.0, p=0.28). No significant differences in ICU or hospital stay, or days alive and free of organ support. |
| Secondary endpoints | ICU and hospital length of stay, days alive and free of organ support |
In adult patients receiving mechanical ventilation and supplemental oxygen in the ICU, minimizing oxygen exposure through conservative oxygen therapy did not significantly reduce all-cause mortality at 90 days.
The trial authors, in the published abstract
With 16500 patients it is decisively neutral, and it closes an argument that ICU-ROX and PILOT had already pushed the same way. Oxygen exposure fell by 29% without benefit or harm, which is a reasonable argument for conservative targets on grounds of resource use rather than outcome. Contrast LOCO2, where a much lower target did cause harm.
Martin DS, Gould DW, Shahid T, et al. Conservative Oxygen Therapy in Mechanically Ventilated Critically Ill Adult Patients: The UK-ROX Randomized Clinical Trial. JAMA 2025 Aug 5;334(5):398-408.