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.Mahidol University2023-10-252023-10-252023-10-01American Journal of Respiratory and Critical Care Medicine Vol.208 No.7 (2023) , 770-7791073449Xhttps://repository.li.mahidol.ac.th/handle/123456789/90736Rationale: 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.MedicineArticleSCOPUS10.1164/rccm.202303-0560OC2-s2.0-851743050401535497037552556