Avoiding hyperoxia may have benefited trauma patients
Targeting low-normal oxygenation in critically ill trauma patients was shown to be safe and probably beneficial, as compared to maintaining higher oxygenation levels. Authors performed a multicenter, cluster-randomized, stepped-wedge trial enrolling almost 14,000 patients at eight level 1 trauma centers, at Colorado, Vanderbilt and OHSU. The trauma centers were randomized to cross over from usual care to a practice of targeting normoxemia (defined here as SpO2 90% to 96% or paO2 60 to 100 mmHg). At 90 days, there was a non-significant reduction in hospital mortality in the post-implementation groups (8.7% vs 11.4%, confidence interval 0.33 to 1.02 favoring benefit).
The near-significant mortality benefit isn’t to be taken at face value — a number needed to treat of 37 to save a life post-trauma with a few fewer mmHg of paO2 seems implausible; patients in the crossover intervention phase may have received more attention generally; assignments were unblinded; other Hawthorne effects wer…
Keep reading with a 7-day free trial
Subscribe to PulmCCM to keep reading this post and get 7 days of free access to the full post archives.