Higher versus lower oxygenation targets in adult ICU patients: A rapid practice guideline

Research output: Contribution to journalJournal articleResearchpeer-review

  • Anders Granholm
  • Zainab Al Duhailib
  • Waleed Alhazzani
  • Emilie Belley-Cote
  • Simon Oczkowski
  • Bharath Kumar Tirupakuzhi Vijayaraghavan
  • Fredrik Sjövall
  • Ethan Butler
  • Fernando G. Zampieri
  • Rob Mac Sweeney
  • Lennie P.G. Derde
  • Ally Ruzycki-Chadwick
  • Mervyn Mer
  • Karen E.A. Burns
  • Begüm Ergan
  • Abdulrahman Al-Fares
  • Michael W. Sjoding
  • Thomas S. Valley
  • Bodil S. Rasmussen
  • Olav L. Schjørring
  • Hallie C. Prescott

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.”.

Original languageEnglish
JournalActa Anaesthesiologica Scandinavica
Issue number3
Pages (from-to)302-310
Number of pages9
Publication statusPublished - 2024

Bibliographical note

Publisher Copyright:
© 2023 Acta Anaesthesiologica Scandinavica Foundation.

    Research areas

  • clinical practice guideline, ICM-RPG, Intensive Care Medicine Rapid Practice Guideline, oxygenation target

ID: 384869864