In Brief |
Unlocking Precision Medicine in Oxygenation Targets for Critically Ill Adults
Estimated read time: 1 minute, 40 seconds
Originally Published: 9 March 2024
Sourced: JAMA
Type of article: In Brief
MedED Catalogue Reference: MCCIB010
Category: Critical Care, Anaesthetics & Emergency Medicine
Cross Reference: Respiratory Physiology
Keywords: precision medicine, oxygenation strategies, SpO2, mortality
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- 1682 patients from the Pragmatic Investigation of Optimal Oxygen Targets (PILOT) trial(US) and
- 965 patients from he Intensive Care Unit Randomized Trial Comparing Two Approaches to Oxygen Therapy (ICU-ROX) trial conducted in 21 ICUs in Australia and New Zealand
The initial model used data obtained from the PILOT study, which was then validated against the results from the Intensive Care Unit Randomized Trial Comparing Two Approaches to Oxygen Therapy (ICU-ROX) study. The outcome measure was 28-day mortality.
The researchers recorded the following:
- In the ICU-ROX validation group, the anticipated impact of lower versus higher Spo2 target treatment on individual patient mortality varied significantly, with mortality rates ranging from a 27.2% absolute decrease to a 34.4% absolute increase in 28-day mortality.
- Patients identified as likely to benefit from a lower Spo2 target had a higher incidence of acute brain injury, whereas those expected to benefit from a higher Spo2 target showed a higher prevalence of sepsis and elevated vital signs.
- Additionally, patients who were projected to benefit from a lower Spo2 target experienced reduced mortality when assigned to the lower Spo2 group, while those predicted to benefit from a higher Spo2 target demonstrated decreased mortality when allocated to the higher Spo2 group (likelihood ratio test for effect modification P = .02).
- Adopting the Spo2 target projected to be most advantageous for each patient, rather than the randomly assigned Spo2 target, could have reduced overall mortality by 6.4% (95% CI, 1.9%-10.9%).
Access the original article
Buell KG, Spicer AB, Casey JD, et al. Individualized Treatment Effects of Oxygen Targets in Mechanically Ventilated Critically Ill Adults. JAMA. 2024;331(14):1195–1204. doi:10.1001/jama.2024.2933
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