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

Morten Hylander Møller^{1

2

3}, Anders Granholm^{1

2

3}, Zainab Al Duhailib^{3

4

5}, Waleed Alhazzani^{3

6

7

8

9}, Emilie Belley-Cote^{3

6

7

10}, Simon Oczkowski^{3

6

7}, Bharath Kumar Tirupakuzhi Vijayaraghavan^{11

12}, Fredrik Sjövall^{13

14}, Ethan Butler^{15

16}, Fernando G Zampieri^{17

18}, Rob Mac Sweeney¹⁹, Lennie P G Derde^{20

21}, Ally Ruzycki-Chadwick²², Mervyn Mer²³, Karen E A Burns^{7

24

25}, Begüm Ergan²⁶, Abdulrahman Al-Fares^{27

28}, Michael W Sjoding²⁹, Thomas S Valley^{29

30}, Bodil S Rasmussen^{31

32}, Olav L Schjørring^{31

32}, Hallie C Prescott^{29

30}

Affiliations

¹ Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
² Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
³ Guidelines in Intensive Care Medicine, Development and Evaluation (GUIDE) Group, Hamilton, Canada.
⁴ Critical Care Medicine Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
⁵ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
⁶ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁸ Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁹ Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
¹⁰ Population Health Research Institute, Hamilton, Ontario, Canada.
¹¹ Department of Critical Care Medicine, Apollo Hospitals, Chennai, India.
¹² The George Institute for Global Health, New Delhi, India.
¹³ Department for Intensive and Perioperative Care, Skane University Hospital, Malmö, Sweden.
¹⁴ Department for Clinical sciences, Lund University, Lund, Sweden.
¹⁵ Department of Intensive Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁶ Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁷ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
¹⁸ Alberta Health Services, Edmonton, Alberta, Canada.
¹⁹ Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK.
²⁰ Intensive Care Center, Division Vital Functions, University Medical Center Utrecht, Utrecht, the Netherlands.
²¹ Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands.
²² Department of Respiratory Therapy General Site, Hamilton Health Sciences, Hamilton, Ontario, Canada.
²³ Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
²⁴ Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
²⁵ Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto, Ontario, Canada.
²⁶ Department of Pulmonary and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
²⁷ Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Minister of Health, Kuwait City, Kuwait.
²⁸ Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Advance Respiratory and Cardiac Failure, Ministry of Health, Kuwait City, Kuwait.
²⁹ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
³⁰ VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.
³¹ Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
³² Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

PMID: 38140827
DOI: 10.1111/aas.14366

Free article

Practice Guideline

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

Morten Hylander Møller et al. Acta Anaesthesiol Scand. 2024 Mar.

Free article

. 2024 Mar;68(3):302-310.

doi: 10.1111/aas.14366. Epub 2023 Dec 23.

Authors

Affiliations

¹ Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
² Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
³ Guidelines in Intensive Care Medicine, Development and Evaluation (GUIDE) Group, Hamilton, Canada.
⁴ Critical Care Medicine Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
⁵ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
⁶ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁸ Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁹ Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
¹⁰ Population Health Research Institute, Hamilton, Ontario, Canada.
¹¹ Department of Critical Care Medicine, Apollo Hospitals, Chennai, India.
¹² The George Institute for Global Health, New Delhi, India.
¹³ Department for Intensive and Perioperative Care, Skane University Hospital, Malmö, Sweden.
¹⁴ Department for Clinical sciences, Lund University, Lund, Sweden.
¹⁵ Department of Intensive Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁶ Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁷ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
¹⁸ Alberta Health Services, Edmonton, Alberta, Canada.
¹⁹ Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK.
²⁰ Intensive Care Center, Division Vital Functions, University Medical Center Utrecht, Utrecht, the Netherlands.
²¹ Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands.
²² Department of Respiratory Therapy General Site, Hamilton Health Sciences, Hamilton, Ontario, Canada.
²³ Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
²⁴ Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
²⁵ Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto, Ontario, Canada.
²⁶ Department of Pulmonary and Critical Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
²⁷ Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Minister of Health, Kuwait City, Kuwait.
²⁸ Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Advance Respiratory and Cardiac Failure, Ministry of Health, Kuwait City, Kuwait.
²⁹ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
³⁰ VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.
³¹ Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
³² Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

PMID: 38140827
DOI: 10.1111/aas.14366

Abstract

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."

Keywords: ICM-RPG; Intensive Care Medicine Rapid Practice Guideline; clinical practice guideline; oxygenation target.

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References

REFERENCES

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

Affiliations

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

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical