The AVF Podcast: ICU Tips & Tricks invites colleagues to share anything and everything on how they deal with various clinical situations. Expect discussions on how experts personalise evidence-based medicine for the patient at the bedside.
In this episode, Professor Paul Young discusses the evidence behind oxygen targets in the intensive care unit (ICU). Professor Young is Deputy Director and Intensive Care Programme Director at the Medical Research Institute of New Zealand, Co-Clinical Lead of the ICU at Wellington Hospital, and the Medical Director of Wakefield Hospital in Wellington, New Zealand. His high-impact studies include the SPLIT trial (JAMA 2015), the HEAT trial (N Engl J Med 2015), the ICU-ROX trial (N Engl J Med 2020), the PEPTIC trial (JAMA 2020), and the VITAMINS trial (JAMA 2020).
Issues discussed in this interview:
· The potential risks of hyperoxia in ICU patients
· Oxygenation targets in the general ICU population as well as for specific patient subsets
· The implications of studies such as ICU-ROX (2020), HOT-ICU (2021), and the ongoing Mega-ROX trial
· Strategies (and the limitations of knowledge) for fine-tuning targets in complicated populations
For more about the Mega-ROX trial, please visit:
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Work cited:
1. Young PJ, Hodgson CL, Rasmussen BS. Oxygen targets. Intensive Care Med 2022;48:732-5.
2. The ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group et al. Conservative oxygen therapy during mechanical ventilation in the ICU. N Engl J Med 2020;382:989-98.
3. Schjorring OL, Klitgaard TL, Perner A, et al. Lower or higher oxygenation targets for acute hypoxemic respiratory failure. N Engl J Med 2021;384:1301-11.
4. Girardis M, Busani S, Damiani E, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the Oxygen-ICU randomized clinical trial. JAMA 2016;316:1583-9.
5. Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 2018;391:1693-705.
6. Asfar P, Schortgen F, Boisrame-Helms J, et al. Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial. Lancet Respir Med 2017;5:180-90.
