Conservative or liberal oxygen therapy for mechanically ventilated adults with acute brain pathologies: A post-hoc subgroup analysis

Paul J Young; Diane Mackle; Carol Hodgson; Rinaldo Bellomo; Michael Bailey; Richard Beasley; Adam M Deane; Glenn Eastwood; Simon Finfer; Ross Freebairn; Victoria King; Natalie Linke; Edward Litton; Colin McArthur; Shay McGuinness; Rakshit Panwar; ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group

doi:10.1016/j.jcrc.2022.154079

Conservative or liberal oxygen therapy for mechanically ventilated adults with acute brain pathologies: A post-hoc subgroup analysis

J Crit Care. 2022 Oct:71:154079. doi: 10.1016/j.jcrc.2022.154079. Epub 2022 Jun 2.

Authors

Paul J Young¹, Diane Mackle², Carol Hodgson³, Rinaldo Bellomo⁴, Michael Bailey⁵, Richard Beasley², Adam M Deane⁶, Glenn Eastwood⁷, Simon Finfer⁸, Ross Freebairn⁹, Victoria King³, Natalie Linke³, Edward Litton¹⁰, Colin McArthur¹¹, Shay McGuinness¹², Rakshit Panwar¹³; ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group

Affiliations

¹ Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia. Electronic address: [email protected].
² Medical Research Institute of New Zealand, Wellington, New Zealand.
³ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
⁴ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia; Intensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australia; Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁵ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australia.
⁶ Intensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australia; Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁷ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia.
⁸ Critical Care Division and Trauma, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; School of Public Health, Imperial College London, London, England, UK.
⁹ Intensive Care Unit, Hawkes Bay Hospital, Hastings, New Zealand.
¹⁰ Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
¹¹ Medical Research Institute of New Zealand, Wellington, New Zealand; Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
¹² Medical Research Institute of New Zealand, Wellington, New Zealand; Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.
¹³ Intensive Care Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.

PMID: 35660843
DOI: 10.1016/j.jcrc.2022.154079

Abstract

Purpose: To compare the effect of conservative vs. liberal oxygen therapy in mechanically ventilated adults in the intensive care unit (ICU) with non-hypoxic ischemic encephalopathy (HIE) acute brain pathologies.

Materials and methods: Post-hoc analysis of data from 217 patients with non-HIE acute brain pathologies included in the ICU Randomized Trial Comparing Two Approaches to OXygen therapy (ICU-ROX).

Results: Patients allocated to conservative oxygen spent less time with oxygen saturation ≥ 97% (50.5 [interquartile range (IQR), 18.5-119] vs. 82 h [IQR, 38-164], absolute difference, -31.5 h; 95%CI, -59.6 to -3.4). At 180 days, 38 of 110 conservative oxygen patients (34.5%) and 28 of 104 liberal oxygen patients (26.9%) had died (absolute difference, 7.6 percentage points; 95%CI, -4.7 to 19.9 percentage points; P = 0.23; interaction P = 0.02 for non-HIE acute brain pathologies vs. HIE; interaction P = 0.53 for non-HIE acute brain pathologies vs. non-neurological conditions).

Conclusions: In this post-hoc analysis, patients admitted to the ICU with non-HIE acute brain pathologies treated with conservative oxygen therapy did not have significantly lower mortality than those treated with liberal oxygen. A trial with adequate statistical power is needed to determine whether our day 180 mortality point estimate of treatment effect favoring liberal oxygen therapy indicates a true effect.

Keywords: Hyperoxia; Hypoxia; Oxygen therapy; Stroke; Subarachnoid hemorrhage; Traumatic brain injury.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brain
Humans
Intensive Care Units
Oxygen
Oxygen Inhalation Therapy*
Respiration, Artificial*

Substances

Oxygen

Associated data

ANZCTR/ACTRN12615000957594