Background

In patients with acute respiratory distress syndrome (ARDS), the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network recommends a target partial pressure of arterial oxygen (Pao₂) between 55 and 80 mm Hg. Prospective validation of this range in patients with ARDS is lacking. We hypothesized that targeting the lower limit of this range would improve outcomes in patients with ARDS.

Methods

In this multicenter, randomized trial, we assigned patients with ARDS to receive either conservative oxygen therapy (target Pao₂, 55 to 70 mm Hg; oxygen saturation as measured by pulse oximetry [Spo₂], 88 to 92%) or liberal oxygen therapy (target Pao₂, 90 to 105 mm Hg; Spo₂, ≥96%) for 7 days. The same mechanical-ventilation strategies were used in both groups. The primary outcome was death from any cause at 28 days.

Results

After the enrollment of 205 patients, the trial was prematurely stopped by the data and safety monitoring board because of safety concerns and a low likelihood of a significant difference between the two groups in the primary outcome. Four patients who did not meet the eligibility criteria were excluded. At day 28, a total of 34 of 99 patients (34.3%) in the conservative-oxygen group and 27 of 102 patients (26.5%) in the liberal-oxygen group had died (difference, 7.8 percentage points; 95% confidence interval [CI], −4.8 to 20.6). At day 90, 44.4% of the patients in the conservative-oxygen group and 30.4% of the patients in the liberal-oxygen group had died (difference, 14.0 percentage points; 95% CI, 0.7 to 27.2). Five mesenteric ischemic events occurred in the conservative-oxygen group.

Conclusions

Among patients with ARDS, early exposure to a conservative-oxygenation strategy with a Pao₂ between 55 and 70 mm Hg did not increase survival at 28 days. (Funded by the French Ministry of Health; LOCO₂ ClinicalTrials.gov number, NCT02713451.)

VISUAL ABSTRACT
Oxygen Therapy in ARDS

中文翻译：

---

急性呼吸窘迫综合征的自由或保守氧疗。

背景

对于急性呼吸窘迫综合征 (ARDS) 患者，美国国家心肺血液研究所 ARDS 临床试验网络建议动脉氧分压 (Pa o ₂ ) 的目标值在 55 至 80 mm Hg 之间。缺乏对 ARDS 患者这一范围的前瞻性验证。我们假设针对这一范围的下限将改善 ARDS 患者的预后。

方法

在这项多中心、随机试验中，我们将 ARDS 患者分配接受保守氧疗（目标 Pa o ₂，55 至 70 mm Hg；通过脉搏血氧饱和度 [Sp o ₂ ] 测量的氧饱和度，88% 至 92%）或自由氧疗法氧疗（目标 Pa o ₂，90 至 105 mm Hg；Sp o ₂，≥96%）7 天。两组均使用相同的机械通气策略。主要结局是 28 天时全因死亡。

结果

在 205 名患者入组后，由于安全问题以及两组在主要结果方面存在显着差异的可能性较低，数据和安全监测委员会提前停止了该试验。四名不符合入选标准的患者被排除在外。在第 28 天，保守氧疗组 99 名患者中的 34 名（34.3%）和自由氧组 102 名患者中的 27 名（26.5%）死亡（差异，7.8 个百分点；95% 置信区间 [ CI]，-4.8 至 20.6)。在第 90 天，保守吸氧组 44.4% 的患者和自由吸氧组 30.4% 的患者死亡（差异，14.0 个百分点；95% CI，0.7 至 27.2）。保守氧疗组发生 5 例肠系膜缺血事件。

结论

在 ARDS 患者中，早期暴露于 Pa o ₂在 55 至 70 mm Hg 之间的保守氧合策略并未增加 28 天的存活率。（由法国卫生部资助；LOCO ₂ ClinicalTrials.gov 编号，NCT02713451。）

ARDS 中的视觉抽象氧疗