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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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viernes, 21 de octubre de 2016

Oxygen-ICU trial

PulmCrit (EM Crit)
PulmCrit Wee - October 19, 2016 - By Josh Farkas
"Among intubated patients, we can often control the pO2, pCO2, and pH. Sounds great. Unfortunately, we also have no idea which numbers we should be targeting. Should we target a normal pH, or permissive hypercapnia? Should we shoot for a normoxia, try to maximize the oxygen delivery (hyperoxia), or allow for permissive hypoxemia? Nobody knows. We check ABGs and tweak the ventilator, but it’s often dubious whether this helps our patients.
Although oxygen is necessary for life, it’s also involved in burning stuff (whether that may be a forest fire or oxidative tissue damage). There is increasing recognition that hyperoxia may be harmful, particularly following cardiac arrest and myocardial infarction (e.g., the AVOID trial). This leads to the current study: is targeting a high oxygen saturation harmful in critically ill patients?..
  • The Oxygen-ICU trial found benefit from a conservative (94-98%) oxygen target when compared to a liberal (97-100%) oxygen target.
  • It is conceivable that targeting a lower oxygen saturation led to lower PEEP and FiO2 levels, facilitating earlier extubation.
  • This study suggests that targeting a saturation of 97-100% may be too high. However, most clinicians may already targeting levels lower than this."