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

Møller, Morten Hylander LU ; Granholm, Anders ; Al Duhailib, Zainab ; Alhazzani, Waleed ; Belley-Cote, Emilie ; Oczkowski, Simon ; Vijayaraghavan, Bharath Kumar Tirupakuzhi ; Sjövall, Fredrik LU orcid ; Butler, Ethan and Zampieri, Fernando G. , et al. (2023) In Acta Anaesthesiologica Scandinavica
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... (More)

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.”.

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publishing date
type
Contribution to journal
publication status
in press
subject
keywords
clinical practice guideline, ICM-RPG, Intensive Care Medicine Rapid Practice Guideline, oxygenation target
in
Acta Anaesthesiologica Scandinavica
publisher
Wiley-Blackwell
external identifiers
  • pmid:38140827
  • scopus:85180730352
ISSN
0001-5172
DOI
10.1111/aas.14366
language
English
LU publication?
yes
id
97aecce1-75ff-4ff2-9257-cba46e5620a6
date added to LUP
2024-02-07 15:48:57
date last changed
2024-04-23 16:05:56
@article{97aecce1-75ff-4ff2-9257-cba46e5620a6,
  abstract     = {{<p>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 SpO<sub>2</sub> 88%–92% or PaO<sub>2</sub> 8 kPa/60 mmHg is relevant and safe for most adult ICU patients.”.</p>}},
  author       = {{Møller, Morten Hylander and Granholm, Anders and Al Duhailib, Zainab and Alhazzani, Waleed and Belley-Cote, Emilie and Oczkowski, Simon and Vijayaraghavan, Bharath Kumar Tirupakuzhi and Sjövall, Fredrik and Butler, Ethan and Zampieri, Fernando G. and Mac Sweeney, Rob and Derde, Lennie P.G. and Ruzycki-Chadwick, Ally and Mer, Mervyn and Burns, Karen E.A. and Ergan, Begüm and Al-Fares, Abdulrahman and Sjoding, Michael W. and Valley, Thomas S. and Rasmussen, Bodil S. and Schjørring, Olav L. and Prescott, Hallie C.}},
  issn         = {{0001-5172}},
  keywords     = {{clinical practice guideline; ICM-RPG; Intensive Care Medicine Rapid Practice Guideline; oxygenation target}},
  language     = {{eng}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Anaesthesiologica Scandinavica}},
  title        = {{Higher versus lower oxygenation targets in adult ICU patients : A rapid practice guideline}},
  url          = {{http://dx.doi.org/10.1111/aas.14366}},
  doi          = {{10.1111/aas.14366}},
  year         = {{2023}},
}