Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC): A Randomized Clinical Trial
Issued Date
2023-10-01
Resource Type
ISSN
1073449X
eISSN
15354970
Scopus ID
2-s2.0-85174305040
Pubmed ID
37552556
Journal Title
American Journal of Respiratory and Critical Care Medicine
Volume
208
Issue
7
Start Page
770
End Page
779
Rights Holder(s)
SCOPUS
Bibliographic Citation
American Journal of Respiratory and Critical Care Medicine Vol.208 No.7 (2023) , 770-779
Suggested Citation
van der Wal L.I., Grim C.C.A., del Prado M.R., van Westerloo D.J., Boerma E.C., Rijnhart-De Jong H.G., Reidinga A.C., Loef B.G., van der Heiden P.L.J., Sigtermans M.J., Paulus F., Cornet A.D., Loconte M., Schoonderbeek F.J., de Keizer N.F., Bakhshi-Raiez F., Le Cessie S., Neto A.S., Pelosi P., Schultz M.J., Helmerhorst H.J.F., de Jonge E. Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC): A Randomized Clinical Trial. American Journal of Respiratory and Critical Care Medicine Vol.208 No.7 (2023) , 770-779. 779. doi:10.1164/rccm.202303-0560OC Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/90736
Title
Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC): A Randomized Clinical Trial
Author(s)
van der Wal L.I.
Grim C.C.A.
del Prado M.R.
van Westerloo D.J.
Boerma E.C.
Rijnhart-De Jong H.G.
Reidinga A.C.
Loef B.G.
van der Heiden P.L.J.
Sigtermans M.J.
Paulus F.
Cornet A.D.
Loconte M.
Schoonderbeek F.J.
de Keizer N.F.
Bakhshi-Raiez F.
Le Cessie S.
Neto A.S.
Pelosi P.
Schultz M.J.
Helmerhorst H.J.F.
de Jonge E.
Grim C.C.A.
del Prado M.R.
van Westerloo D.J.
Boerma E.C.
Rijnhart-De Jong H.G.
Reidinga A.C.
Loef B.G.
van der Heiden P.L.J.
Sigtermans M.J.
Paulus F.
Cornet A.D.
Loconte M.
Schoonderbeek F.J.
de Keizer N.F.
Bakhshi-Raiez F.
Le Cessie S.
Neto A.S.
Pelosi P.
Schultz M.J.
Helmerhorst H.J.F.
de Jonge E.
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Amsterdam Public Health
IRCCS San Martino Polyclinic Hospital
Medisch Centrum Leeuwarden
Diakonessenhuis Utrecht
Ikazia Hospital
Martini Ziekenhuis
Hospital Israelita Albert Einstein
Leids Universitair Medisch Centrum
Faculty of Medicine, Nursing and Health Sciences
Rijksuniversiteit Groningen
Nuffield Department of Medicine
Medisch Spectrum Twente (MST)
Austin Hospital
Reinier de Graaf Hospital - SSDZ
Amsterdam Public Health
IRCCS San Martino Polyclinic Hospital
Medisch Centrum Leeuwarden
Diakonessenhuis Utrecht
Ikazia Hospital
Martini Ziekenhuis
Hospital Israelita Albert Einstein
Leids Universitair Medisch Centrum
Faculty of Medicine, Nursing and Health Sciences
Rijksuniversiteit Groningen
Nuffield Department of Medicine
Medisch Spectrum Twente (MST)
Austin Hospital
Reinier de Graaf Hospital - SSDZ
Other Contributor(s)
Abstract
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 (PaO2, 55–80 mm Hg; or oxygen saturation as measured by pulse oximetry, 91–94%) or high-oxygenation (PaO2, 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 PaO2 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.