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Wando Mount Pleasant Library
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Individualized Treatment Effects of Oxygen Targets in Mechanically Ventilated Critically Ill Adults.
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- Author(s): Buell, Kevin G.; Spicer, Alexandra B.; Casey, Jonathan D.; Seitz, Kevin P.; Qian, Edward T.; Graham Linck, Emma J.; Self, Wesley H.; Rice, Todd W.; Sinha, Pratik; Young, Paul J.; Semler, Matthew W.; Churpek, Matthew M.
- Source:
JAMA: Journal of the American Medical Association. 4/9/2024, Vol. 331 Issue 14, p1195-1204. 10p. - Source:
- Additional Information
- Subject Terms:
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- Abstract: Key Points: Question: Among critically ill adults, do the effects of peripheral oxygen-saturation (Spo2) targets on outcomes differ based on an individual's characteristics? Findings: A machine learning model derived in one randomized trial and validated in another found that the predicted effect of lower vs higher Spo2 targets ranged from a 27% absolute reduction to a 34% absolute increase in 28-day mortality and differed significantly based on an individual's characteristics. Meaning: The effect of oxygen-saturation targets on mortality varied by patients' individual characteristics. Importance: Among critically ill adults, randomized trials have not found oxygenation targets to affect outcomes overall. Whether the effects of oxygenation targets differ based on an individual's characteristics is unknown. Objective: To determine whether an individual's characteristics modify the effect of lower vs higher peripheral oxygenation-saturation (Spo2) targets on mortality. Design, Setting, and Participants: A machine learning model to predict the effect of treatment with a lower vs higher Spo2 target on mortality for individual patients was derived in the Pragmatic Investigation of Optimal Oxygen Targets (PILOT) trial and externally validated in the Intensive Care Unit Randomized Trial Comparing Two Approaches to Oxygen Therapy (ICU-ROX) trial. Critically ill adults received invasive mechanical ventilation in an intensive care unit (ICU) in the United States between July 2018 and August 2021 for PILOT (n = 1682) and in 21 ICUs in Australia and New Zealand between September 2015 and May 2018 for ICU-ROX (n = 965). Exposures: Randomization to a lower vs higher Spo2 target group. Main Outcome and Measure: 28-Day mortality. Results: In the ICU-ROX validation cohort, the predicted effect of treatment with a lower vs higher Spo2 target for individual patients ranged from a 27.2% absolute reduction to a 34.4% absolute increase in 28-day mortality. For example, patients predicted to benefit from a lower Spo2 target had a higher prevalence of acute brain injury, whereas patients predicted to benefit from a higher Spo2 target had a higher prevalence of sepsis and abnormally elevated vital signs. Patients predicted to benefit from a lower Spo2 target experienced lower mortality when randomized to the lower Spo2 group, whereas patients predicted to benefit from a higher Spo2 target experienced lower mortality when randomized to the higher Spo2 group (likelihood ratio test for effect modification P =.02). The use of a Spo2 target predicted to be best for each patient, instead of the randomized Spo2 target, would have reduced the absolute overall mortality by 6.4% (95% CI, 1.9%-10.9%). Conclusion and relevance: Oxygenation targets that are individualized using machine learning analyses of randomized trials may reduce mortality for critically ill adults. A prospective trial evaluating the use of individualized oxygenation targets is needed. This cohort study examines whether peripheral oxygenation-saturation targets on mortality would differ by individual patient characteristics among 2 temporally and geographically distinct randomized trials of lower vs higher Spo2 targets in critically ill patients receiving mechanical ventilation [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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