Written by Aaron Lacy
Spoon Feed
There was no difference in patient-centered outcomes between trauma patients who received either restrictive or liberal oxygen therapy in this RCT.
Bull or bear on O2 for trauma patients?
ATLS recommends that severely injured trauma patients receive early oxygen supplementation, despite there being little evidence to support this. Contrarily, there is growing concern that liberal oxygen therapy for critically ill patients may lead to worse patient outcomes. The TRAUMOX2-RCT randomized 1508 adult patients who arrived as trauma activations to either a restrictive (target SpO2 94%; n=733) or liberal (12-15L O2 for 8 hours; n=724) oxygen therapy strategy. There was no difference in death or major respiratory complication (e.g. pneumonia, ARDS) within 30 days between the restrictive (16.1%) vs liberal (16.7%) groups (OR 1.01, 95%CI 0.75-1.37). There was no difference when looking at death or major respiratory complications separately, either. Notably, the study excluded 471 patients who were randomized but ultimately had minor or no injuries after evaluation and had no subsequent collection of data related to outcomes of interest.
How will this change my practice?
I place all leveled trauma patients on oxygen upon arrival to the resuscitation bay, assuming the worst and to start preoxygenation in case an airway is urgently required. Unless the patient is going directly to the operating room or requires intubation I normally stop oxygen unless the patient requires it to maintain adequate saturations. I don’t plan to change that based on this RCT.
Source
Early Restrictive vs Liberal Oxygen for Trauma Patients: The TRAUMOX2 Randomized Clinical Trial. JAMA. 2024 Dec 10. doi: 10.1001/jama.2024.25786. Epub ahead of print. PMID: 39657224
