Restrictive oxygen comparable to liberal oxygen in adults with trauma

Key takeaways:

• Restrictive oxygen was defined as an arterial oxygen saturation target of 94%.
• A similar proportion of patients receiving restrictive vs. liberal oxygen died and/or experienced a major respiratory complication.

There was no difference in an 8-hour restrictive vs. an 8-hour liberal early oxygen strategy given to adult trauma patients when evaluating death and/or major respiratory complications by day 30, according to results published in JAMA.

“The evidence supporting the administration of supplemental oxygen to all severely injured trauma patients in the initial period is notably scarce,” Tobias Arleth, MD, PhD fellow at Rigshospitalet, Copenhagen University Hospital, and colleagues wrote.

In the multicenter, randomized, controlled TRAUMOX2 trial, Arleth and colleagues assessed 1,508 adult trauma patients (median age, 50 years; 73% men; median Injury Severity Score, 14) who received either an 8-hour restrictive oxygen strategy (defined as an arterial oxygen saturation target of 94%) or an 8-hour liberal oxygen strategy (defined as 12 L to 15 L of oxygen per minute or fraction of inspired oxygen of 0.6-1) to uncover if one strategy is better than the other with respect to the rate of death and/or major respiratory complications at the 30-day mark.

Notably, patients received the oxygen strategies in the prehospital setting or on trauma center admission, according to the study.

After only considering those with data for the outcomes of interest, the restrictive oxygen group included 733 patients, and the liberal oxygen group included 724 patients.

By day 30, researchers observed that a similar proportion of patients receiving restrictive oxygen and patients receiving liberal oxygen died and/or experienced a major respiratory complication (16.1% vs. 16.7%).

This pattern of similar proportions in the two groups continued during the evaluation of only death at day 30 (restrictive oxygen, 8.6% vs. liberal oxygen, 7.3%) and only major respiratory complications at day 30 (restrictive oxygen, 8.9% vs. liberal oxygen, 10.8%), according to the study.

In terms of safety, researchers noted that those receiving restrictive oxygen had a comparable proportion of patients who experienced the adverse event of irritability of airway mucosa to those receiving liberal oxygen (2.1% vs. 2.6%). All serious adverse events between the groups were found to have the same pattern.

In contrast, the occurrence of the adverse event of atelectasis did differ between the two groups (restrictive oxygen, 27.6% vs. liberal oxygen, 34.7%), according to researchers.

“In adult trauma patients, a restrictive oxygen strategy compared with a liberal oxygen strategy initiated in the prehospital setting or on trauma center admission for a duration of 8 hours did not significantly reduce death and/or major respiratory complications within 30 days,” Arleth and colleagues wrote.