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Effect of low-normal vs high-normal oxygenation targets on organ dysfunction in critically ill patients

JAMA Sep 19, 2021

Gelissen H, de Grooth HJ, Smulders Y, et al. - No statistically significant reduction in organ dysfunction was conferred by treatment with a low-normal PaO2 target vs a high-normal PaO2 target in critically ill patients with 2 or more systemic inflammatory response syndrome (SIRS) criteria.

  • Increase in organ dysfunction in critically ill patients may result from hyperoxemia.

  • This randomized clinical trial included 400 patients in the ICU with at least 2 positive SIRS criteria.

  • SOFA RANK , a ranked outcome of nonrespiratory organ failure quantified by the nonrespiratory components of SOFA score, summed over the first 14 study days, was the primary endpoint.

  • Randomization of patients to a target PaO2 range of 8 to 12 kPa vs 14 to 18 kPa led to a median SOFA RANK score of −35 vs −40 (lower score implies less organ failure severity), a difference that was not statistically significant.

  • In terms of median duration of mechanical ventilation and in-hospital mortality, no significant difference was observed between groups.

  • In the low-normal and high-normal PaO2 groups, occurrence of acute kidney failure was seen in 20 patients (10%) and 21 patients (11%), respectively, and that of acute myocardial infarction in 6 patients (2.9%) and 7 patients (3.6%), respectively.

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