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Critical Care Medicine:
doi: 10.1097/CCM.0000000000000219
Clinical Investigations

Conservative Oxygen Therapy in Mechanically Ventilated Patients: A Pilot Before-and-After Trial*

Suzuki, Satoshi MD, PhD1; Eastwood, Glenn M. PhD1; Glassford, Neil J. MD, MRCP1; Peck, Leah RN1; Young, Helen RN1; Garcia-Alvarez, Mercedes MD1; Schneider, Antoine G. MD1; Bellomo, Rinaldo MD, FCICM1,2

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Abstract

Objectives: To assess the feasibility and safety of a conservative approach to oxygen therapy in mechanically ventilated ICU patients.

Design: Pilot prospective before-and-after study.

Setting: A 22-bed multidisciplinary ICU of a tertiary care hospital in Australia.

Patients: A total of 105 adult (18 years old or older) patients required mechanical ventilation for more than 48 hours: 51 patients during the “conventional” before period and 54 after a change to “conservative” oxygen therapy.

Interventions: Implementation of a conservative approach to oxygen therapy (target SpO2 of 90–92%).

Measurements and Main Results: We collected 3,169 datasets on 799 mechanical ventilation days. During conservative oxygen therapy the median time-weighted average SpO2 on mechanical ventilation was 95.5% (interquartile range, 94.0–97.3) versus 98.4% (97.3–99.1) (p < 0.001) during conventional therapy. The median PaO2 was 83 torr (71–94) versus 107 torr (94–131) (p < 0.001) with a change to a median FIO2 of 0.27 (0.24–0.30) versus 0.40 (0.35–0.44) (p < 0.001). Conservative oxygen therapy decreased the median total amount of oxygen delivered during mechanical ventilation by about two thirds (15,580 L [8,263–29,351 L] vs 5,122 L [1,837–10,499 L]; p < 0.001). The evolution of the PaO2/FIO2 ratio was similar during the two periods, and there were no difference in any other biochemical or clinical outcomes.

Conclusions: Conservative oxygen therapy in mechanically ventilated ICU patients was feasible and free of adverse biochemical, physiological, or clinical outcomes while allowing a marked decrease in excess oxygen exposure. Our study supports the safety and feasibility of future pilot randomized controlled trials of conventional compared with conservative oxygen therapy.

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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