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- emergency ambulance systems
- prehospital care
- critical care transport
- intensive care
- cardiac arrest
This month’s update is by the Research in Emergency care, Avon Collaborative Hub. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.
The papers are ranked as:
Worth a peek—interesting, but not yet ready for prime time.
Head turner—new concepts.
Game changer—this paper could/should change practice.
Effect of low-normal vs high-normal oxygenation targets on organ dysfunction in critically ill patients: a randomized clinical trial by Gelissen et aI
Topic: critical care
Rating: worth a peek
There is known to be a U-shaped relationship between mortality and oxygen concentrations in critically ill patients.1 2 This multicentre randomised controlled trial (RCT) compared low-normal against high-normal arterial oxygen pressure (PaO2) in critically ill patients with systematic inflammatory response syndrome (SIRS).
Four hundred adults with ≥2 SIRS criteria, admitted to the intensive care unit (ICU) with an expected stay of 48 hours or longer, were randomised to PaO2 targets of 8–12 kPa (low) or 14–18 kPa (high). The primary outcome was based on daily Sequential Organ Failure Assessment (SOFA) scores, summed over day 1–14, and ranked (SOFA-RANK). Participants were ranked from fastest organ failure improvement (lowest scores) to worsening organ failure or death (highest scores). The range of SOFA-RANK results was between minus scores (low) and positive scores (high).
There was no significant difference in organ dysfunction at 14 days; median SOFA-RANK score was −35 (IQR −63 to 0) in the 8–12 kPa group vs −40 (IQR −76 to −4.5) in the 14–18 kPa group, median difference 10 (95% CI 0 to 21, p=0.06). There was no difference in secondary outcomes including 90-day mortality, duration of ventilation or length of ICU stay.
There was no loss …
Twitter @eddcarlton, @ternfellow
Contributors LJ, YT, FB, DM-B and JS produced the research summaries. EC was responsible for editing and approving drafts. TR was responsible for organisation, editing and submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.