TOPLINE:
Maintaining targeted oxygen support at 90%-96% did not significantly increase supplemental oxygen–free days for approximately 1 month but safely reduced the use of supplemental oxygen without increasing episodes of hypoxemia, death, or adverse events among critically-ill patients.
METHODOLOGY:
- Supplemental oxygen is commonly used in critically-ill patients to prevent hypoxemia (peripheral oxygen saturation [SpO2], < 88%), but excessive use can lead to hyperoxemia (SpO2, > 96%) and oxidative damage. Targeting normoxemia (SpO2, 90%-96%) could safely reduce exposure to hyperoxemia.
- Researchers conducted a multicenter, randomized clinical trial to assess the effectiveness and safety of maintaining targeted normoxemia vs standard care in critically-ill patients with trauma admitted to surgical or trauma intensive care units across the United States from July 2020 to November 2022.
- They included 12,487 patients (mean age, 51.7 years; 70.5% men) from randomly assigned sites that underwent crossover every 3 months over 28 months, alternating between the targeted normoxemia group (n = 5661) and the standard care group (n = 6826).
- The targeted normoxemia group used education and health record alerts to adjust oxygen levels, aiming for an SpO2 of 90%-96% (or a partial pressure of oxygen of 60-100 mm Hg) and reducing oxygen when SpO2 exceeded 96%. In contrast, supplemental oxygen levels in the standard care group were determined by treating clinicians.
- The primary outcome was supplemental oxygen–free days, defined as days alive without supplemental oxygen, through day 28; secondary outcomes included ventilator-free days through day 28, in-hospital mortality by day 90, and hospital-free days through day 90.
TAKEAWAY:
- The mean supplemental oxygen–free days through day 28 was 19.6 days for the targeted normoxemia group and 17.5 days for the standard care group, with the between-group difference not being statistically significant.
- Patients in the targeted normoxemia group were weaned to room air earlier than those in the standard care group (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.33).
- Targeted normoxemia group showed reduced hyperoxemia (26.7% vs 42.4%), whereas hypoxemia remained unchanged in both groups (1.1% vs 1.1%).
- Secondary outcomes such as ventilator-free days by day 28 and in-hospital mortality by day 90 were not significantly different between the groups, and no adverse events were reported in either group during the study period
IN PRACTICE:
“The clinical implication of these findings is that among critically injured adults, targeting normoxemia can safely decrease use and expedite liberation from supplemental oxygen,” the authors wrote.
SOURCE:
This study was led by David J. Douin, MD, University of Colorado School of Medicine, Aurora, Colorado. It was published online on March 31, 2025, in JAMA Network Open.
LIMITATIONS:
This study’s stepped-wedge design led to some baseline imbalances between the groups, potentially affecting results. Adherence to protocol varied across study sites. The COVID-19 pandemic may have influenced the implementation of the intervention and its findings. Moreover, post-discharge and long-term outcomes beyond 90 days were not assessed.
DISCLOSURES:
This study was supported by the US Department of Defense Special Operations Command, the Office of the Assistant Secretary of Defense for Health Affairs, and J9 and the Research and Development Directorate of the Defense Health Agency. Some authors reported receiving research grants from various research organizations, receiving personal or consulting fees, or serving on medical advisory boards of pharmaceutical and healthcare companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.