Intensive care unit randomised trial comparing two approaches to oxygen therapy (ICU-ROX): results of the pilot phase

Paul J Young, Diane M Mackle, Michael J Bailey, Richard W Beasley, Victoria Bennett, Adam M Deane, Glenn M Eastwood, Simon Finfer, Ross C Freebairn, Edward Litton, Natalie Linke, Colin J McArthur, Shay P McGuinness, Rakshit Panwar, Rinaldo Bellomo, The ICU-ROX pilot investigators , Leah Peck, Helen Young, David Closey, Seton HendersonJan Mehrtens, Emmeline Minto, Anna Morris, Sascha Noble, Kim Parker, Annamaria Palermo, Susan Pellicano, Maude Carpenter, Danielle Hacking, Ywain Lawrey, Sarah Doherty, Kathleen Glasby, Alex Poole, Justine Rivett, Anna Hunt, Sally Hurford, Leanlove Navarra, The Australian and New Zealand Intensive Care Society Clinical Trials Group , Raulle Sol Cruz

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Abstract

OBJECTIVE: The objective of the intensive care unit randomised trial comparing two approaches to oxygen therapy (ICU-ROX) pilot phase, which included the first 100 patients of an overall sample of 1000, was to examine feasibility. DESIGN: Investigator-initiated, prospective, parallel-group, pilot randomised controlled trial. SETTING: Six medical-surgical intensive care units (ICUs) in Australia and New Zealand, with participants recruited from September 2015 through June 2016. PARTICIPANTS: 100 patients ≥ 18 years of age who required invasive mechanical ventilation in the ICU and were expected to be receiving it beyond the next calendar day at the time of randomisation. INTERVENTIONS: Conservative oxygen therapy or standard care. MAIN OUTCOME MEASURES: Eligibility, recruitment rate, and separation in oxygen exposure (fraction of inspired oxygen [FiO2] and oxygen saturation measured by pulse oximetry [SpO2Z]). RESULTS: 94 of 99 participants (94.9%) were confirmed by study monitors to fulfil the study eligibility criteria. 3.6 patients per site per month were enrolled (95% confidence interval [CI], 2.5-4.7). Patients allocated to conservative oxygen therapy spent significantly more time on an FiO2 of 0.21 in the ICU; median, 31.5 hours (interquartile range [IQR], 7-63.5) for conservative oxygen therapy patients v 0 hours for standard oxygen therapy patients (IQR, 0-10; midpoint difference, 21.5 hours; 95% CI, 9-34; P < 0.0001). Patients allocated to conservative oxygen therapy spent less time in the ICU with an SpO2Z of ≥ 97% than patients allocated to standard oxygen therapy; median, 18.5 hours (IQR, 5-46) for conservative oxygen therapy patients v 32 hours for standard oxygen therapy (IQR, 17-80; midpoint difference, 13.5 hours; 95% CI, 2-25; P = 0.02). CONCLUSIONS: Our findings confirm the feasibility of completing the ICU-ROX trial without the need for substantive changes to the study protocol for the remaining 900 trial participants. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTRN 12615000957594).

Original languageEnglish
Pages (from-to)344-354
Number of pages11
JournalCritical Care and Resuscitation
Volume19
Issue number4
Publication statusPublished - Dec 2017

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