IOTA - Oxygen, Less Is More

Written by Clay Smith

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For adults with varied acute illnesses, use of supplemental oxygen in patients with room air SpO2 of 94% or greater was associated with increased short and longterm mortality.

Why does this matter?
Patients who are acutely ill, with normal or slightly low SpO2 are often placed on oxygen to keep saturations at or near 100%.  But several studies have called this practice into question for acute MI, stroke, and critical illness.  What does a broader look at the literature show?

IOTA avoid giving too much oxygen
This was a meta-analysis of 25 RCTs including 16,037 acutely ill adult patients of various types (sepsis, critical illness, stroke, trauma, myocardial infarction, cardiac arrest, or emergency surgery) that received either a liberal or conservative oxygen strategy.  Those who received a more liberal oxygen strategy, median SpO2 96% or more, fared worse, with increased in-hospital, 30-day, and longterm mortality.  Overall, 11 more people per 1000 would die in-hospital with a liberal oxygen strategy.  In critically ill patients, 40 more patients per 1000 would die from excessive supplemental oxygen.  In practical terms, if a patient has a room air SpO2 of 94% or greater, avoid supplemental oxygen.

Source
Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis.  Lancet. 2018 Apr 28;391(10131):1693-1705. doi: 10.1016/S0140-6736(18)30479-3. Epub 2018 Apr 26.
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Reviewed by Thomas Davis

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