Examination of Personalized SpO2 Targets
Vanderbilt University Medical Center
Summary
Mechanical ventilation involves titrating the fraction of inspired oxygen to maintain arterial oxygen saturation (SpO2). The SpO2 target that results in the best outcomes for critically ill adults has historically been unknown. Randomized trials comparing use of a higher SpO2 target (96-100%) vs a lower SpO2 target (88-92%) have not found an average treatment effect among patients overall. However, the optimal SpO2 target may differ for patients with different characteristics. Recently, data from randomized trials of SpO2 targets were used to derive and validate a statistical model that predicts which SpO2 target will result in the best outcomes for an individual patient based on his or her unique characteristics (personalized SpO2 target). This statistical model has been incorporated into the electronic health record at Vanderbilt such that, for each patient receiving mechanical ventilation in the medical intensive care unit, information on which SpO2 target is predicted to result in the best outcome for the patient can be made available to clinicians. However, the use of personalized SpO2 targets for critically ill adults receiving mechanical ventilation has never been examined in a randomized trial and whether using such a personalized SpO2 target in clinical care can improve patient outcomes remains unknown. This randomized trial will examine the effect of using information on the SpO2 target that is predicted to be best for a patient based on his or her unique characteristics (personalized SpO2 target) versus usual care.
Description
Each year, 2-3 million critically ill adults in the United States receive invasive mechanical ventilation. In-hospital mortality among critically ill adults receiving mechanical ventilation remains approximately 25-35%. Approaches to care that decrease mortality for critically ill adults receiving invasive mechanical ventilation are urgently needed. Mechanical ventilation universally involves titrating the fraction of inspired oxygen (FiO2) to maintain arterial oxygen saturation - as assessed by pulse oximetry (SpO2) or blood gas analysis (SaO2) - or arterial oxygen tension (e.g., PaO2). Usin…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Patient is located in a participating unit * Patient is receiving invasive mechanical ventilation Exclusion Criteria: * Patient is known to be less than 18 years old * Patient is known to be pregnant * Patient is known to be a prisoner * Patient is receiving extracorporeal membrane oxygenation * Clinician has determined that a specific approach to oxygen therapy is required or contraindicated for the optimal care of the patient
Interventions
- OtherPersonalized SpO2 Target
A personalized SpO2 target predicted to result in the best outcomes for a patient will be delivered by the physicians, nurses, and respiratory therapists as a part of routine clinical care.
- OtherUsual Care
Clinicians will determine the approach to supplemental oxygen administration without receiving information from the statistical model
Location
- Vanderbilt University Medical CenterNashville, Tennessee