دورية أكاديمية
أعرض في EDS

Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC): A Randomized Clinical Trial.

التفاصيل البيبلوغرافية
العنوان: Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC): A Randomized Clinical Trial.
المؤلفون: van der Wal LI; Department of Intensive Care.; Department of Anesthesiology, and., Grim CCA; Department of Intensive Care.; Department of Anesthesiology, and., Del Prado MR; Department of Intensive Care., van Westerloo DJ; Department of Intensive Care., Boerma EC; Department of Sustainable Health, Campus Fryslân, University of Groningen, Groningen, The Netherlands.; Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands., Rijnhart-de Jong HG; Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands., Reidinga AC; Department of Intensive Care, Martini Hospital, Groningen, The Netherlands., Loef BG; Department of Intensive Care, Martini Hospital, Groningen, The Netherlands., van der Heiden PLJ; Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands., Sigtermans MJ; Department of Intensive Care, Diakonessenhuis, Utrecht, The Netherlands., Paulus F; Department of Intensive Care and., Cornet AD; Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands., Loconte M; Department of Anesthesiology and Intensive Care and., Schoonderbeek FJ; Department of Intensive Care, Ikazia Hospital, Rotterdam, The Netherlands., de Keizer NF; Department of Medical Informatics, Amsterdam Public Health - Digital Health, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands., Bakhshi-Raiez F; Department of Medical Informatics, Amsterdam Public Health - Digital Health, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands., Le Cessie S; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands., Serpa Neto A; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Critical Care Medicine, Albert Einstein Israelite Hospital, São Paulo, Brazil.; Department of Intensive Care, Austin Hospital, Melbourne, Australia., Pelosi P; Department of Anesthesiology and Intensive Care and.; Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, Scientific Institute for Research, Hospitalization and Healthcare for Oncology and Neurosciences, Genoa, Italy., Schultz MJ; Department of Intensive Care and.; Mahidol - Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; and.; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom., Helmerhorst HJF; Department of Anesthesiology, and., de Jonge E; Department of Intensive Care.
مؤلفون مشاركون: ICONIC investigators
المصدر: American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2023 Oct 01; Vol. 208 (7), pp. 770-779.
نوع المنشور: Randomized Controlled Trial; Multicenter Study; Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Internet ISSN: 1535-4970 (Electronic) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE
أسماء مطبوعة: Publication: 2000- : New York, NY : American Thoracic Society
Original Publication: New York, NY : American Lung Association, c1994-
مواضيع طبية MeSH: Pandemics* , COVID-19*/therapy, Humans ; Critical Care ; Oximetry ; Intensive Care Units ; Respiration, Artificial
مستخلص: Rationale: Supplemental oxygen is widely administered to ICU patients, but appropriate oxygenation targets remain unclear. Objectives: This study aimed to determine whether a low-oxygenation strategy would lower 28-day mortality compared with a high-oxygenation strategy. Methods: This randomized multicenter trial included mechanically ventilated ICU patients with an expected ventilation duration of at least 24 hours. Patients were randomized 1:1 to a low-oxygenation (Pa O 2 , 55-80 mm Hg; or oxygen saturation as measured by pulse oximetry, 91-94%) or high-oxygenation (Pa O 2 , 110-150 mm Hg; or oxygen saturation as measured by pulse oximetry, 96-100%) target until ICU discharge or 28 days after randomization, whichever came first. The primary outcome was 28-day mortality. The study was stopped prematurely because of the COVID-19 pandemic when 664 of the planned 1,512 patients were included. Measurements and Main Results: Between November 2018 and November 2021, a total of 664 patients were included in the trial: 335 in the low-oxygenation group and 329 in the high-oxygenation group. The median achieved Pa O 2 was 75 mm Hg (interquartile range, 70-84) and 115 mm Hg (interquartile range, 100-129) in the low- and high-oxygenation groups, respectively. At Day 28, 129 (38.5%) and 114 (34.7%) patients had died in the low- and high-oxygenation groups, respectively (risk ratio, 1.11; 95% confidence interval, 0.9-1.4; P  = 0.30). At least one serious adverse event was reported in 12 (3.6%) and 17 (5.2%) patients in the low- and high-oxygenation groups, respectively. Conclusions: Among mechanically ventilated ICU patients with an expected mechanical ventilation duration of at least 24 hours, using a low-oxygenation strategy did not result in a reduction of 28-day mortality compared with a high-oxygenation strategy. Clinical trial registered with the National Trial Register and the International Clinical Trials Registry Platform (NTR7376).
التعليقات: Comment in: Am J Respir Crit Care Med. 2023 Oct 1;208(7):746-748. (PMID: 37610828)
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فهرسة مساهمة: Investigator: J Wigbers; F Termorshuizen; C Klop; L Dawson; Y Schriel-van den Berg; E de Vreede; J Qualm; M Koopmans; T Krol; M Rinket; W Vermeijden; A Beishuizen; J van Holten; A Tsonas; M Botta; T Winters; J Horn; D Battaglini; L Ball; I Brunetti
Keywords: hyperoxia; hypoxia; intensive care medicine; mechanical ventilation; oxygen
سلسلة جزيئية: NTR NTR7376
تواريخ الأحداث: Date Created: 20230808 Date Completed: 20231109 Latest Revision: 20231129
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC10563190
DOI: 10.1164/rccm.202303-0560OC
PMID: 37552556
قاعدة البيانات: MEDLINE
الوصف
تدمد:1535-4970
DOI:10.1164/rccm.202303-0560OC