High vs. low oxygenation targets in mechanically ventilated patients.
Further evidence from the ICONIC trial suggests oxygenation that seems “good enough” in vented patients, probably is.
Authors randomized 664 patients receiving mechanical ventilation to receive oxygen to a target paO2 55-80 mm Hg (low oxygenation) or 110-150 mm Hg (high oxygenation). At 28 days, 38% of the low-oxygenation patients had died, vs. 35% of the high-oxygenation patients (risk ratio 1.11, with a 95% confidence interval of 0.9-1.4, P=0.30). There were no significant differences in adverse events.
The study was stopped in November 2021 due to the Covid-19 pandemic, at just over half of its intended enrollment, reducing its power. I’m not enough of a statistician to say how this affects the strength of its conclusions, and whether full enrollment could have changed them.
However, it’s unlikely. A larger trial of 2500 patients published in NEJM in 2022 showed no difference in outcomes among patients ventilated wit…
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