LOCO2
Trial question
Is conservative oxygenation strategy superior to liberal oxygenation strategy in patients with ARDS?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 201
201 patients (72 female, 129 male).
Inclusion criteria: patients who had undergone intubation and had been receiving mechanical ventilation for < 12 hours for ARDS.
Key exclusion criteria: long-term oxygen therapy or noninvasive ventilation at home; hospitalization for cardiac arrest, traumatic brain injury, or cranial hypertension.
Interventions
N=99 a conservative oxygen strategy (target partial pressure of arterial oxygen between 55 and 70 mmHg; oxygen saturation as measured by pulse oximetry between 88 and 92% for 7 days).
N=102 a liberal oxygen strategy (target partial pressure of arterial oxygen of 90 to 105 mmHg; oxygen saturation as measured by pulse oximetry ≥ 96% for 7 days).
Primary outcome
Death at 28 days
34.3%
26.5%
34.3 %
25.7 %
17.1 %
8.6 %
0.0 %
A conservative oxygen
strategy
A liberal oxygen
strategy
No significant
difference ↔
No significant difference in death at 28 days (34.3% vs. 26.5%; AD 7.8%, 95% CI -4.8 to 20.6).
Secondary outcomes
Significant increase in death at 90 days (44.4% vs. 30.4%; AD 14%, 95% CI 0.7 to 27.2).
Safety outcomes
No significant differences in infections, mechanical ventilation, seizure or delirium.
Significant difference in mesenteric ischemia (5.1% vs. 0%).
Conclusion
In patients who had undergone intubation and had been receiving mechanical ventilation for < 12 hours for ARDS, a conservative oxygen strategy was not superior to a liberal oxygen strategy with respect to death at 28 days.
Reference
Loic Barrot, Pierre Asfar, Frederic Mauny et al. Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome. N Engl J Med. 2020 Mar 12;382(11):999-1008.
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