Liberal Oxygenation Versus Conservative Oxygenation in ARDS
Status:
Unknown status
Trial end date:
2019-09-28
Target enrollment:
Participant gender:
Summary
No clear recommendation exists for the level of oxygenation of intensive care patients. In
Acute Respiratory Distress Syndrome (ARDS), pulsed oxymetry (SpO2) have to be kept between 88
and 95 percent and oxygen alveolar pressure between 55 and 80 mmHg (PaO2). These
recommendations are common but do not lie on high scientific knowledge and level of proof. In
the major studies of these fifteen last years that changed ARDS management, PaO2 was kept
around 85 and 90 mmHg despite current recommendations of 55 to 80 mmHg of PaO2.
Many recent review and cohort studies pointed the risk of excessive oxygenation especially
following cardiac arrest, stroke or traumatic brain injury. However, these data come in
majority from cohort or database study without strong definition of hyperoxia. Data coming
from prospective studies are scarce and tend to show better outcome of patients with lower
objectives of oxygenation in ICU.
High oxygen (O2) level may be deleterious especially on inflammatory lungs. It could enhance
injuries due to mechanical ventilation. O2 could be responsable of " hyperoxia induced lung
injury ".
The investigators showed in a precedent study that comparing a restrictive oxygenation versus
a liberal oxygenation was feasable and do not expose patients to major adverse events. More,
mortality at 60 days has tendency to be lower. The investigators therefore ask if a lower
objectives of PaO2 in comparison with the level usually seen in last studies on ARDS could
improve ARDS patients outcome.
The aim of this study is to show that a restrictive oxygenation in comparison with a liberal
oxygenation strategy in patients with ARDS would lower mortality at 28 days.