Conservative oxygen therapy for mechanically ventilated adults with sepsis: a post hoc analysis of data from the intensive care unit randomized trial comparing two approaches to oxygen therapy (ICU-ROX)
Purpose Sepsis is a common reason for intensive care unit (ICU) admission and mortality in ICU patients. Despite increasing interest in treatment strategies limiting oxygen exposure in ICU patients, no trials have compared conservative vs. usual oxygen in patients with sepsis. Methods We undertook a...
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| Veröffentlicht in: | Intensive care medicine 2020-01, Vol.46 (1), p.17-26 |
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| creator | Young, Paul Mackle, Diane Bellomo, Rinaldo Bailey, Michael Beasley, Richard Deane, Adam Eastwood, Glenn Finfer, Simon Freebairn, Ross King, Victoria Linke, Natalie Litton, Edward McArthur, Colin McGuinness, Shay Panwar, Rakshit |
| description | Purpose
Sepsis is a common reason for intensive care unit (ICU) admission and mortality in ICU patients. Despite increasing interest in treatment strategies limiting oxygen exposure in ICU patients, no trials have compared conservative vs. usual oxygen in patients with sepsis.
Methods
We undertook a post hoc analysis of the 251 patients with sepsis enrolled in a trial that compared conservative oxygen therapy with usual oxygen therapy in 1000 mechanically ventilated ICU patients. The primary end point for the current analysis was 90-day mortality. Key secondary outcomes were cause-specific mortality, ICU and hospital length of stay, ventilator-free days, vasopressor-free days, and the proportion of patients receiving renal replacement therapy in the ICU.
Results
Patients with sepsis allocated to conservative oxygen therapy spent less time in the ICU with an SpO
2
≥ 97% (23.5 h [interquartile range (IQR) 8–70] vs. 47 h [IQR 11–93], absolute difference, 23 h; 95% CI 8–38), and more time receiving an FiO
2
of 0.21 than patients allocated to usual oxygen therapy (20.5 h [IQR 1–79] vs. 0 h [IQR 0–10], absolute difference, 20 h; 95% CI 14–26). At 90-days, 47 of 130 patients (36.2%) assigned to conservative oxygen and 35 of 120 patients (29.2%) assigned to usual oxygen had died (absolute difference, 7 percentage points; 95% CI − 4.6 to 18.6% points;
P
= 0.24; interaction
P
= 0.35 for sepsis vs. non-sepsis). There were no statistically significant differences between groups for secondary outcomes but point estimates of treatment effects consistently favored usual oxygen therapy.
Conclusions
Point estimates for the treatment effect of conservative oxygen therapy on 90-day mortality raise the possibility of clinically important harm with this intervention in patients with sepsis; however, our post hoc analysis was not powered to detect the effects suggested and our data do not exclude clinically important benefit or harm from conservative oxygen therapy in this patient group.
Clinical Trials Registry
ICU-ROX Australian and New Zealand Clinical Trials Registry number ACTRN12615000957594. |
| doi_str_mv | 10.1007/s00134-019-05857-x |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7223684</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A723889729</galeid><sourcerecordid>A723889729</sourcerecordid><originalsourceid>FETCH-LOGICAL-c579t-c03a4d34ca60b4002dbefdc36bacf229bb25c565b273369231058516fcdfad1e3</originalsourceid><addsrcrecordid>eNp9ks1q3DAUhU1padK0L9BFEXSTLpzqx5Y9XQTC0J9AIFAa6E5cy_JYQZZcSZ7M9BH7VJU7adKEoWghuPrOueJwsuw1wScE4-p9wJiwIsdkkeOyLqt88yQ7JAWjOaGsfpodYlbQvOAFPchehHCd8IqX5Hl2wEhV1DXjh9mvpbNB-TVEvVbIbbYrZVHslYdxizrn0aBkD1ZLMGaL1spGbSCqFkE7mRjQjY49CmoMOnxAgEYXIuqdRGDBbNMQuQ61EAF13g2zMdI2KhvmbRK8QpPVEXmwrRv0z-QbvQaDpBtG8NquULxxCMbRO5C9Cii6x588Pl9e5V8vv797mT3rwAT16vY-yq4-ffy2_JJfXH4-X55d5LKsFjGXmEHRskICx02BMW0b1bWS8QZkR-miaWgpS142tGKMLygjc7iEd7LtoCWKHWWnO99xagbVypSJByNGrwfwW-FAi4cvVvdi5daiopTxukgGx7cG3v2YVIhi0EEqY8AqNwWRVvKqZolO6NtH6LWbfMp2pgpWMkI4v6dWYJTQtnNpr5xNxVmVqlAvKrpIVL6HSlGmHI2zqtNp_IA_2cOn06pBy70CuhNI70LwqrvLhGAxN1bsGitSY8WfxopNEr35N807yd-KJoDtgDDOhVD-PoL_2P4Gls_7Xw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2343531166</pqid></control><display><type>article</type><title>Conservative oxygen therapy for mechanically ventilated adults with sepsis: a post hoc analysis of data from the intensive care unit randomized trial comparing two approaches to oxygen therapy (ICU-ROX)</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Young, Paul ; Mackle, Diane ; Bellomo, Rinaldo ; Bailey, Michael ; Beasley, Richard ; Deane, Adam ; Eastwood, Glenn ; Finfer, Simon ; Freebairn, Ross ; King, Victoria ; Linke, Natalie ; Litton, Edward ; McArthur, Colin ; McGuinness, Shay ; Panwar, Rakshit</creator><creatorcontrib>Young, Paul ; Mackle, Diane ; Bellomo, Rinaldo ; Bailey, Michael ; Beasley, Richard ; Deane, Adam ; Eastwood, Glenn ; Finfer, Simon ; Freebairn, Ross ; King, Victoria ; Linke, Natalie ; Litton, Edward ; McArthur, Colin ; McGuinness, Shay ; Panwar, Rakshit ; ICU-ROX Investigators the Australian New Zealand Intensive Care Society Clinical Trials Group ; the ICU-ROX Investigators the Australian New Zealand Intensive Care Society Clinical Trials Group</creatorcontrib><description>Purpose
Sepsis is a common reason for intensive care unit (ICU) admission and mortality in ICU patients. Despite increasing interest in treatment strategies limiting oxygen exposure in ICU patients, no trials have compared conservative vs. usual oxygen in patients with sepsis.
Methods
We undertook a post hoc analysis of the 251 patients with sepsis enrolled in a trial that compared conservative oxygen therapy with usual oxygen therapy in 1000 mechanically ventilated ICU patients. The primary end point for the current analysis was 90-day mortality. Key secondary outcomes were cause-specific mortality, ICU and hospital length of stay, ventilator-free days, vasopressor-free days, and the proportion of patients receiving renal replacement therapy in the ICU.
Results
Patients with sepsis allocated to conservative oxygen therapy spent less time in the ICU with an SpO
2
≥ 97% (23.5 h [interquartile range (IQR) 8–70] vs. 47 h [IQR 11–93], absolute difference, 23 h; 95% CI 8–38), and more time receiving an FiO
2
of 0.21 than patients allocated to usual oxygen therapy (20.5 h [IQR 1–79] vs. 0 h [IQR 0–10], absolute difference, 20 h; 95% CI 14–26). At 90-days, 47 of 130 patients (36.2%) assigned to conservative oxygen and 35 of 120 patients (29.2%) assigned to usual oxygen had died (absolute difference, 7 percentage points; 95% CI − 4.6 to 18.6% points;
P
= 0.24; interaction
P
= 0.35 for sepsis vs. non-sepsis). There were no statistically significant differences between groups for secondary outcomes but point estimates of treatment effects consistently favored usual oxygen therapy.
Conclusions
Point estimates for the treatment effect of conservative oxygen therapy on 90-day mortality raise the possibility of clinically important harm with this intervention in patients with sepsis; however, our post hoc analysis was not powered to detect the effects suggested and our data do not exclude clinically important benefit or harm from conservative oxygen therapy in this patient group.
Clinical Trials Registry
ICU-ROX Australian and New Zealand Clinical Trials Registry number ACTRN12615000957594.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-019-05857-x</identifier><identifier>PMID: 31748836</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject><![CDATA[Adult ; Aged ; Anesthesiology ; Australia ; Care and treatment ; Clinical trials ; Comparative analysis ; Conservatism ; Conservative Treatment - methods ; Conservative Treatment - standards ; Conservative Treatment - statistics & numerical data ; Critical Care Medicine ; Emergency Medicine ; Female ; Health aspects ; Hospital patients ; Humans ; Infection ; Intensive ; Intensive care ; Intensive Care Units - organization & administration ; Intensive Care Units - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; New Zealand ; Original ; Oxygen ; Oxygen Inhalation Therapy - methods ; Oxygen Inhalation Therapy - standards ; Oxygen Inhalation Therapy - statistics & numerical data ; Oxygen therapy ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Respiration, Artificial - methods ; Respiration, Artificial - standards ; Respiration, Artificial - statistics & numerical data ; Respiratory therapy ; Sepsis ; Sepsis - physiopathology ; Sepsis - therapy ; Statistical analysis ; Therapy ; Treatment Outcome]]></subject><ispartof>Intensive care medicine, 2020-01, Vol.46 (1), p.17-26</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>COPYRIGHT 2020 Springer</rights><rights>Intensive Care Medicine is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c579t-c03a4d34ca60b4002dbefdc36bacf229bb25c565b273369231058516fcdfad1e3</citedby><cites>FETCH-LOGICAL-c579t-c03a4d34ca60b4002dbefdc36bacf229bb25c565b273369231058516fcdfad1e3</cites><orcidid>0000-0002-3428-3083</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-019-05857-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-019-05857-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31748836$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Young, Paul</creatorcontrib><creatorcontrib>Mackle, Diane</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Bailey, Michael</creatorcontrib><creatorcontrib>Beasley, Richard</creatorcontrib><creatorcontrib>Deane, Adam</creatorcontrib><creatorcontrib>Eastwood, Glenn</creatorcontrib><creatorcontrib>Finfer, Simon</creatorcontrib><creatorcontrib>Freebairn, Ross</creatorcontrib><creatorcontrib>King, Victoria</creatorcontrib><creatorcontrib>Linke, Natalie</creatorcontrib><creatorcontrib>Litton, Edward</creatorcontrib><creatorcontrib>McArthur, Colin</creatorcontrib><creatorcontrib>McGuinness, Shay</creatorcontrib><creatorcontrib>Panwar, Rakshit</creatorcontrib><creatorcontrib>ICU-ROX Investigators the Australian New Zealand Intensive Care Society Clinical Trials Group</creatorcontrib><creatorcontrib>the ICU-ROX Investigators the Australian New Zealand Intensive Care Society Clinical Trials Group</creatorcontrib><title>Conservative oxygen therapy for mechanically ventilated adults with sepsis: a post hoc analysis of data from the intensive care unit randomized trial comparing two approaches to oxygen therapy (ICU-ROX)</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Purpose
Sepsis is a common reason for intensive care unit (ICU) admission and mortality in ICU patients. Despite increasing interest in treatment strategies limiting oxygen exposure in ICU patients, no trials have compared conservative vs. usual oxygen in patients with sepsis.
Methods
We undertook a post hoc analysis of the 251 patients with sepsis enrolled in a trial that compared conservative oxygen therapy with usual oxygen therapy in 1000 mechanically ventilated ICU patients. The primary end point for the current analysis was 90-day mortality. Key secondary outcomes were cause-specific mortality, ICU and hospital length of stay, ventilator-free days, vasopressor-free days, and the proportion of patients receiving renal replacement therapy in the ICU.
Results
Patients with sepsis allocated to conservative oxygen therapy spent less time in the ICU with an SpO
2
≥ 97% (23.5 h [interquartile range (IQR) 8–70] vs. 47 h [IQR 11–93], absolute difference, 23 h; 95% CI 8–38), and more time receiving an FiO
2
of 0.21 than patients allocated to usual oxygen therapy (20.5 h [IQR 1–79] vs. 0 h [IQR 0–10], absolute difference, 20 h; 95% CI 14–26). At 90-days, 47 of 130 patients (36.2%) assigned to conservative oxygen and 35 of 120 patients (29.2%) assigned to usual oxygen had died (absolute difference, 7 percentage points; 95% CI − 4.6 to 18.6% points;
P
= 0.24; interaction
P
= 0.35 for sepsis vs. non-sepsis). There were no statistically significant differences between groups for secondary outcomes but point estimates of treatment effects consistently favored usual oxygen therapy.
Conclusions
Point estimates for the treatment effect of conservative oxygen therapy on 90-day mortality raise the possibility of clinically important harm with this intervention in patients with sepsis; however, our post hoc analysis was not powered to detect the effects suggested and our data do not exclude clinically important benefit or harm from conservative oxygen therapy in this patient group.
Clinical Trials Registry
ICU-ROX Australian and New Zealand Clinical Trials Registry number ACTRN12615000957594.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesiology</subject><subject>Australia</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Comparative analysis</subject><subject>Conservatism</subject><subject>Conservative Treatment - methods</subject><subject>Conservative Treatment - standards</subject><subject>Conservative Treatment - statistics & numerical data</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Health aspects</subject><subject>Hospital patients</subject><subject>Humans</subject><subject>Infection</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive Care Units - organization & administration</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>New Zealand</subject><subject>Original</subject><subject>Oxygen</subject><subject>Oxygen Inhalation Therapy - methods</subject><subject>Oxygen Inhalation Therapy - standards</subject><subject>Oxygen Inhalation Therapy - statistics & numerical data</subject><subject>Oxygen therapy</subject><subject>Pain Medicine</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Respiration, Artificial - methods</subject><subject>Respiration, Artificial - standards</subject><subject>Respiration, Artificial - statistics & numerical data</subject><subject>Respiratory therapy</subject><subject>Sepsis</subject><subject>Sepsis - physiopathology</subject><subject>Sepsis - therapy</subject><subject>Statistical analysis</subject><subject>Therapy</subject><subject>Treatment Outcome</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9ks1q3DAUhU1padK0L9BFEXSTLpzqx5Y9XQTC0J9AIFAa6E5cy_JYQZZcSZ7M9BH7VJU7adKEoWghuPrOueJwsuw1wScE4-p9wJiwIsdkkeOyLqt88yQ7JAWjOaGsfpodYlbQvOAFPchehHCd8IqX5Hl2wEhV1DXjh9mvpbNB-TVEvVbIbbYrZVHslYdxizrn0aBkD1ZLMGaL1spGbSCqFkE7mRjQjY49CmoMOnxAgEYXIuqdRGDBbNMQuQ61EAF13g2zMdI2KhvmbRK8QpPVEXmwrRv0z-QbvQaDpBtG8NquULxxCMbRO5C9Cii6x588Pl9e5V8vv797mT3rwAT16vY-yq4-ffy2_JJfXH4-X55d5LKsFjGXmEHRskICx02BMW0b1bWS8QZkR-miaWgpS142tGKMLygjc7iEd7LtoCWKHWWnO99xagbVypSJByNGrwfwW-FAi4cvVvdi5daiopTxukgGx7cG3v2YVIhi0EEqY8AqNwWRVvKqZolO6NtH6LWbfMp2pgpWMkI4v6dWYJTQtnNpr5xNxVmVqlAvKrpIVL6HSlGmHI2zqtNp_IA_2cOn06pBy70CuhNI70LwqrvLhGAxN1bsGitSY8WfxopNEr35N807yd-KJoDtgDDOhVD-PoL_2P4Gls_7Xw</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Young, Paul</creator><creator>Mackle, Diane</creator><creator>Bellomo, Rinaldo</creator><creator>Bailey, Michael</creator><creator>Beasley, Richard</creator><creator>Deane, Adam</creator><creator>Eastwood, Glenn</creator><creator>Finfer, Simon</creator><creator>Freebairn, Ross</creator><creator>King, Victoria</creator><creator>Linke, Natalie</creator><creator>Litton, Edward</creator><creator>McArthur, Colin</creator><creator>McGuinness, Shay</creator><creator>Panwar, Rakshit</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3428-3083</orcidid></search><sort><creationdate>20200101</creationdate><title>Conservative oxygen therapy for mechanically ventilated adults with sepsis: a post hoc analysis of data from the intensive care unit randomized trial comparing two approaches to oxygen therapy (ICU-ROX)</title><author>Young, Paul ; Mackle, Diane ; Bellomo, Rinaldo ; Bailey, Michael ; Beasley, Richard ; Deane, Adam ; Eastwood, Glenn ; Finfer, Simon ; Freebairn, Ross ; King, Victoria ; Linke, Natalie ; Litton, Edward ; McArthur, Colin ; McGuinness, Shay ; Panwar, Rakshit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c579t-c03a4d34ca60b4002dbefdc36bacf229bb25c565b273369231058516fcdfad1e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesiology</topic><topic>Australia</topic><topic>Care and treatment</topic><topic>Clinical trials</topic><topic>Comparative analysis</topic><topic>Conservatism</topic><topic>Conservative Treatment - methods</topic><topic>Conservative Treatment - standards</topic><topic>Conservative Treatment - statistics & numerical data</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Health aspects</topic><topic>Hospital patients</topic><topic>Humans</topic><topic>Infection</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive Care Units - organization & administration</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>New Zealand</topic><topic>Original</topic><topic>Oxygen</topic><topic>Oxygen Inhalation Therapy - methods</topic><topic>Oxygen Inhalation Therapy - standards</topic><topic>Oxygen Inhalation Therapy - statistics & numerical data</topic><topic>Oxygen therapy</topic><topic>Pain Medicine</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Respiration, Artificial - methods</topic><topic>Respiration, Artificial - standards</topic><topic>Respiration, Artificial - statistics & numerical data</topic><topic>Respiratory therapy</topic><topic>Sepsis</topic><topic>Sepsis - physiopathology</topic><topic>Sepsis - therapy</topic><topic>Statistical analysis</topic><topic>Therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Young, Paul</creatorcontrib><creatorcontrib>Mackle, Diane</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>Bailey, Michael</creatorcontrib><creatorcontrib>Beasley, Richard</creatorcontrib><creatorcontrib>Deane, Adam</creatorcontrib><creatorcontrib>Eastwood, Glenn</creatorcontrib><creatorcontrib>Finfer, Simon</creatorcontrib><creatorcontrib>Freebairn, Ross</creatorcontrib><creatorcontrib>King, Victoria</creatorcontrib><creatorcontrib>Linke, Natalie</creatorcontrib><creatorcontrib>Litton, Edward</creatorcontrib><creatorcontrib>McArthur, Colin</creatorcontrib><creatorcontrib>McGuinness, Shay</creatorcontrib><creatorcontrib>Panwar, Rakshit</creatorcontrib><creatorcontrib>ICU-ROX Investigators the Australian New Zealand Intensive Care Society Clinical Trials Group</creatorcontrib><creatorcontrib>the ICU-ROX Investigators the Australian New Zealand Intensive Care Society Clinical Trials Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Young, Paul</au><au>Mackle, Diane</au><au>Bellomo, Rinaldo</au><au>Bailey, Michael</au><au>Beasley, Richard</au><au>Deane, Adam</au><au>Eastwood, Glenn</au><au>Finfer, Simon</au><au>Freebairn, Ross</au><au>King, Victoria</au><au>Linke, Natalie</au><au>Litton, Edward</au><au>McArthur, Colin</au><au>McGuinness, Shay</au><au>Panwar, Rakshit</au><aucorp>ICU-ROX Investigators the Australian New Zealand Intensive Care Society Clinical Trials Group</aucorp><aucorp>the ICU-ROX Investigators the Australian New Zealand Intensive Care Society Clinical Trials Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Conservative oxygen therapy for mechanically ventilated adults with sepsis: a post hoc analysis of data from the intensive care unit randomized trial comparing two approaches to oxygen therapy (ICU-ROX)</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>46</volume><issue>1</issue><spage>17</spage><epage>26</epage><pages>17-26</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><abstract>Purpose
Sepsis is a common reason for intensive care unit (ICU) admission and mortality in ICU patients. Despite increasing interest in treatment strategies limiting oxygen exposure in ICU patients, no trials have compared conservative vs. usual oxygen in patients with sepsis.
Methods
We undertook a post hoc analysis of the 251 patients with sepsis enrolled in a trial that compared conservative oxygen therapy with usual oxygen therapy in 1000 mechanically ventilated ICU patients. The primary end point for the current analysis was 90-day mortality. Key secondary outcomes were cause-specific mortality, ICU and hospital length of stay, ventilator-free days, vasopressor-free days, and the proportion of patients receiving renal replacement therapy in the ICU.
Results
Patients with sepsis allocated to conservative oxygen therapy spent less time in the ICU with an SpO
2
≥ 97% (23.5 h [interquartile range (IQR) 8–70] vs. 47 h [IQR 11–93], absolute difference, 23 h; 95% CI 8–38), and more time receiving an FiO
2
of 0.21 than patients allocated to usual oxygen therapy (20.5 h [IQR 1–79] vs. 0 h [IQR 0–10], absolute difference, 20 h; 95% CI 14–26). At 90-days, 47 of 130 patients (36.2%) assigned to conservative oxygen and 35 of 120 patients (29.2%) assigned to usual oxygen had died (absolute difference, 7 percentage points; 95% CI − 4.6 to 18.6% points;
P
= 0.24; interaction
P
= 0.35 for sepsis vs. non-sepsis). There were no statistically significant differences between groups for secondary outcomes but point estimates of treatment effects consistently favored usual oxygen therapy.
Conclusions
Point estimates for the treatment effect of conservative oxygen therapy on 90-day mortality raise the possibility of clinically important harm with this intervention in patients with sepsis; however, our post hoc analysis was not powered to detect the effects suggested and our data do not exclude clinically important benefit or harm from conservative oxygen therapy in this patient group.
Clinical Trials Registry
ICU-ROX Australian and New Zealand Clinical Trials Registry number ACTRN12615000957594.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31748836</pmid><doi>10.1007/s00134-019-05857-x</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-3428-3083</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2020-01, Vol.46 (1), p.17-26 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7223684 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aged Anesthesiology Australia Care and treatment Clinical trials Comparative analysis Conservatism Conservative Treatment - methods Conservative Treatment - standards Conservative Treatment - statistics & numerical data Critical Care Medicine Emergency Medicine Female Health aspects Hospital patients Humans Infection Intensive Intensive care Intensive Care Units - organization & administration Intensive Care Units - statistics & numerical data Male Medicine Medicine & Public Health Middle Aged Mortality New Zealand Original Oxygen Oxygen Inhalation Therapy - methods Oxygen Inhalation Therapy - standards Oxygen Inhalation Therapy - statistics & numerical data Oxygen therapy Pain Medicine Patients Pediatrics Pneumology/Respiratory System Respiration, Artificial - methods Respiration, Artificial - standards Respiration, Artificial - statistics & numerical data Respiratory therapy Sepsis Sepsis - physiopathology Sepsis - therapy Statistical analysis Therapy Treatment Outcome |
| title | Conservative oxygen therapy for mechanically ventilated adults with sepsis: a post hoc analysis of data from the intensive care unit randomized trial comparing two approaches to oxygen therapy (ICU-ROX) |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T03%3A04%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Conservative%20oxygen%20therapy%20for%20mechanically%20ventilated%20adults%20with%20sepsis:%20a%20post%20hoc%20analysis%20of%20data%20from%20the%20intensive%20care%20unit%20randomized%20trial%20comparing%20two%20approaches%20to%20oxygen%20therapy%20(ICU-ROX)&rft.jtitle=Intensive%20care%20medicine&rft.au=Young,%20Paul&rft.aucorp=ICU-ROX%20Investigators%20the%20Australian%20New%20Zealand%20Intensive%20Care%20Society%20Clinical%20Trials%20Group&rft.date=2020-01-01&rft.volume=46&rft.issue=1&rft.spage=17&rft.epage=26&rft.pages=17-26&rft.issn=0342-4642&rft.eissn=1432-1238&rft_id=info:doi/10.1007/s00134-019-05857-x&rft_dat=%3Cgale_pubme%3EA723889729%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2343531166&rft_id=info:pmid/31748836&rft_galeid=A723889729&rfr_iscdi=true |