Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC)
In this study, the effectiveness of different oxygenation strategies in intensive care unit (ICU) patients was investigated. The aim was to determine if a low-oxygenation strategy, targeting lower levels of oxygen in the blood, would lead to lower 28-day mortality compared to a high-oxygenation strategy, where higher oxygen levels were maintained.
The study involved a randomized multicenter trial with mechanically ventilated ICU patients who were expected to require ventilation for at least 24 hours. Patients were divided into two groups: the low-oxygenation group (targeting a PaO2 of 55-80 mmHg or SpO2 of 91-94%) and the high-oxygenation group (targeting a PaO2 of 110-150 mmHg or SpO2 of 96-100%). The primary outcome assessed was 28-day mortality.
Between November 2018 and November 2021, a total of 664 patients were included in the trial. The achieved PaO2 levels were 75 mmHg in the low-oxygenation group and 115 mmHg in the high-oxygenation group. By day 28, 38.5% of patients in the low-oxygenation group and 34.7% in the high-oxygenation group had died. The risk ratio for mortality was 1.11, with a confidence interval of 0.9-1.4, and a p-value of 0.30. Serious adverse events were reported in a small percentage of patients in both groups.
The study concluded that among mechanically ventilated ICU patients with an expected ventilation duration of at least 24 hours, using a low-oxygenation strategy did not lead to a reduction in 28-day mortality compared to a high-oxygenation strategy.
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