TY - JOUR
T1 - Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC)
T2 - A Randomized Clinical Trial
AU - van der Wal, L. Imeen
AU - Grim, Chloe C.A.
AU - del Prado, Michael R.
AU - van Westerloo, David J.
AU - Boerma, E. Christiaan
AU - Rijnhart-De Jong, Hilda G.
AU - Reidinga, Auke C.
AU - Loef, Bert G.
AU - van der Heiden, Pim L.J.
AU - Sigtermans, Marnix J.
AU - Paulus, Frederique
AU - Cornet, Alexander D.
AU - Loconte, Maurizio
AU - Schoonderbeek, F. Jeannette
AU - de Keizer, Nicolette F.
AU - Bakhshi-Raiez, Ferishta
AU - Le Cessie, Saskia
AU - Neto, Ary Serpa
AU - Pelosi, Paolo
AU - Schultz, Marcus J.
AU - Helmerhorst, Hendrik J.F.
AU - de Jonge, Evert
AU - for the ICONIC investigators
N1 - Funding Information:
Supported by the Nederlandse Organisatie voor Wetenschappelijk Onderzoek (NWO) (project number 401.16.009). The NWO was not involved in the study design, the collection of the data, the analysis or interpretation of the data, the writing of the report, or the decision to submit the paper for publication.
Funding Information:
The study was funded by the Dutch Research Council (project number 401.16.009). An independent data and safety monitoring board (DSMB) periodically reviewed blinded efficacy and safety data, with the option to request unblinded data if required.
Publisher Copyright:
Copyright © 2023 by the American Thoracic Society.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - 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.
AB - 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.
KW - hyperoxia
KW - hypoxia
KW - intensive care medicine
KW - mechanical ventilation
KW - oxygen
UR - http://www.scopus.com/inward/record.url?scp=85174305040&partnerID=8YFLogxK
U2 - 10.1164/rccm.202303-0560OC
DO - 10.1164/rccm.202303-0560OC
M3 - Article
C2 - 37552556
AN - SCOPUS:85174305040
SN - 1073-449X
VL - 208
SP - 770
EP - 779
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 7
ER -