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Master of Public Health

Oxygen-Saturation Targets and Cognitive and Functional Outcomes in Mechanically Ventilated Adults

AUTHORS

Mart MF , Semler MW , Jenkins CA , Wang G , Casey JD , Ely EW , Jackson JC , Kiehl AL , Bryant PT , Pugh SK , Wang L , DeMasi S , Rice TW , Bernard GR , Freundlich RE , Self WH , Han JH , . American journal of respiratory and critical care medicine. 2024 1 29; ().

ABSTRACT

RATIONALE: Among mechanically ventilated critically ill adults, the Pragmatic Investigation of Optimal Oxygen Targets (PILOT) trial found no difference in ventilator-free days between lower, intermediate, and higher oxygen-saturation targets. The effects on long-term cognition and related outcomes are unknown.

OBJECTIVES: To compare the effects of lower (90%, range 88-92%), intermediate (94%, range 92-96%), and higher oxygen-saturation (98%, range 96-100%) targets on long-term outcomes.

METHODS: Twelve months after enrollment in the PILOT trial, blinded neuropsychological raters conducted assessments of cognition, disability, employment status, and quality of life. The primary outcome was global cognition as measured by the Telephone Montreal Cognitive Assessment (T-MoCA). In a subset of patients, an expanded neuropsychological battery measured executive function, attention, immediate and delayed memory, verbal fluency, and abstraction.

MEASUREMENTS AND MAIN RESULTS: A total of 501 patients completed follow-up including 142 in the lower, 186 in the intermediate, and 173 in the higher oxygen target groups. Median (IQR) SpO values in the lower, intermediate, and higher-target groups were 94% (91,96), 95% (93,97), and 97% (95,99), respectively. The T-MoCA score did not differ between lower and intermediate (adjusted OR,1.36; 95% CI, 0.92 to 2.00), intermediate and higher (adjusted OR, 0.90; 95%CI, 0.62 to 1.29), or higher and lower target groups (adjusted OR, 1.22; 95% CI, 0.83 to 1.79). There was also no difference in individual cognitive domains, disability, employment, or quality of life.

CONCLUSIONS: Among mechanically ventilated critically ill adults who completed follow up at 12 months, oxygen-saturation targets were not associated with cognition or related outcomes.

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