TY - JOUR

T1 - Higher versus lower oxygenation targets in adult ICU patients

T2 - A rapid practice guideline

AU - Møller, Morten Hylander

AU - Granholm, Anders

AU - Al Duhailib, Zainab

AU - Alhazzani, Waleed

AU - Belley-Cote, Emilie

AU - Oczkowski, Simon

AU - Vijayaraghavan, Bharath Kumar Tirupakuzhi

AU - Sjövall, Fredrik

AU - Butler, Ethan

AU - Zampieri, Fernando G.

AU - Mac Sweeney, Rob

AU - Derde, Lennie P.G.

AU - Ruzycki-Chadwick, Ally

AU - Mer, Mervyn

AU - Burns, Karen E.A.

AU - Ergan, Begüm

AU - Al-Fares, Abdulrahman

AU - Sjoding, Michael W.

AU - Valley, Thomas S.

AU - Rasmussen, Bodil S.

AU - Schjørring, Olav L.

AU - Prescott, Hallie C.

N1 - Publisher Copyright: © 2023 Acta Anaesthesiologica Scandinavica Foundation.

PY - 2024

Y1 - 2024

N2 - The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) was to provide evidence-based clinical guidance about the use of higher versus lower oxygenation targets for adult patients in the intensive care unit (ICU). The guideline panel comprised 27 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. We adhered to the methodology for trustworthy clinical practice guidelines, including the use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and used the Evidence-to-Decision framework to generate recommendations. A recently published updated systematic review and meta-analysis constituted the evidence base. Through teleconferences and web-based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients' values and preferences, costs and resources, equity, feasibility, acceptability, and research priorities. The updated systematic review and meta-analysis included data from 17 randomized clinical trials with 10,248 participants. There was little to no difference between the use of higher versus lower oxygenation targets for all outcomes with available data, including all-cause mortality, serious adverse events, stroke, functional outcomes, cognition, and health-related quality of life (very low certainty of evidence). The panel felt that values and preferences, costs and resources, and equity favored the use of lower oxygenation targets. The ICM-RPG panel issued one conditional recommendation against the use of higher oxygenation targets: “We suggest against the routine use of higher oxygenation targets in adult ICU patients (conditional recommendation, very low certainty of evidence). Remark: an oxygenation target of SpO2 88%–92% or PaO2 8 kPa/60 mmHg is relevant and safe for most adult ICU patients.”.

AB - The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) was to provide evidence-based clinical guidance about the use of higher versus lower oxygenation targets for adult patients in the intensive care unit (ICU). The guideline panel comprised 27 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. We adhered to the methodology for trustworthy clinical practice guidelines, including the use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and used the Evidence-to-Decision framework to generate recommendations. A recently published updated systematic review and meta-analysis constituted the evidence base. Through teleconferences and web-based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients' values and preferences, costs and resources, equity, feasibility, acceptability, and research priorities. The updated systematic review and meta-analysis included data from 17 randomized clinical trials with 10,248 participants. There was little to no difference between the use of higher versus lower oxygenation targets for all outcomes with available data, including all-cause mortality, serious adverse events, stroke, functional outcomes, cognition, and health-related quality of life (very low certainty of evidence). The panel felt that values and preferences, costs and resources, and equity favored the use of lower oxygenation targets. The ICM-RPG panel issued one conditional recommendation against the use of higher oxygenation targets: “We suggest against the routine use of higher oxygenation targets in adult ICU patients (conditional recommendation, very low certainty of evidence). Remark: an oxygenation target of SpO2 88%–92% or PaO2 8 kPa/60 mmHg is relevant and safe for most adult ICU patients.”.

KW - clinical practice guideline

KW - ICM-RPG

KW - Intensive Care Medicine Rapid Practice Guideline

KW - oxygenation target

U2 - 10.1111/aas.14366

DO - 10.1111/aas.14366

M3 - Journal article

C2 - 38140827

AN - SCOPUS:85180730352

VL - 68

SP - 302

EP - 310

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 3

ER -