Verdict No. 2365 · Search date 2026-08-07 · Methodology v0.7
Conservative oxygen target,
does it really help with Lower all-cause mortality in critically ill adults?
30-Second Summary
D
Evidence Grade D · 34 · Safety caution
Conservative oxygen targeting did not reduce mortality in mechanically ventilated ICU adults
Both hypoxemia and hyperoxemia can harm; clinicians should individualize targets using diagnosis, blood gases, and pulse-oximeter limitations.
What the
research showsThe grade is D. UK-ROX randomized 16,500 mechanically ventilated adults to an SpO2 target of 90% (range 88-92%) or usual oxygen. Ninety-day mortality was 35.4% versus 34.9%, adjusted risk difference +0.7 points (95% CI -0.7 to +2.0). No validated minimum mortality-benefit threshold was identified, so this is D rather than F.
research showsThe grade is D. UK-ROX randomized 16,500 mechanically ventilated adults to an SpO2 target of 90% (range 88-92%) or usual oxygen. Ninety-day mortality was 35.4% versus 34.9%, adjusted risk difference +0.7 points (95% CI -0.7 to +2.0). No validated minimum mortality-benefit threshold was identified, so this is D rather than F.
What the
ads claimLess oxygen is not one uniform treatment. The SpO2 or PaO2 target, range, comparator ceiling, duration, and population must be specified.
ads claimLess oxygen is not one uniform treatment. The SpO2 or PaO2 target, range, comparator ceiling, duration, and population must be specified.
Useful facts when choosing a product
- UK-ROX targeted SpO2 90% with an 88-92% range.
- HOT-ICU tested PaO2 targets of 60 versus 90 mm Hg.
- Serious adverse events in UK-ROX were 0.7% versus 0.4%, without a significant mortality subgroup interaction.
Gap Measurement · Verdict 2365 · D 34
What the research actually shows
UK-ROX analyzed 16,394 participants for the primary outcome, with 2908/8211 versus 2858/8183 deaths. ICU-ROX randomized 1,000 and found 21.3 versus 22.1 ventilator-free days; 180-day mortality was 170/476 versus 164/475. HOT-ICU randomized 2,928 and analyzed mortality in 2,888. PILOT included 2,541 in its primary analysis.
Why this is classified as D (34)
The most direct large mortality trial was null, and no validated benefit-exclusion boundary supports F; D with 34 points.
Counterpoint. Signals in ARDS, sepsis, or hypoxic-ischemic encephalopathy subgroups remain exploratory.
Rejudgment record. Cross-check applied — A precise null 90-day mortality result in UK-ROX, trial-to-trial target differences, and no validated benefit threshold
Scoring profile behind this grade
| Endpoint | H | Hard endpoint - actual events such as death |
| Replication | R1 | Single confirmatory trial |
| Independence | I2 | Decisive evidence is publicly or non-profit funded |
| Effect size | E0 | Null |
| Precision | C0 | The confidence interval leaves room for benefit |
The scoring table and the verdict agree (D).
Sub-claim grades by effect
This ingredient is marketed for several effects. A single overall grade blends strong and weak claims together, so each effect is graded separately here. The overall grade reflects the strongest disconfirming or core claim.
| Effect (sub-claim) | Grade | Basis |
|---|---|---|
| Lower 90-day mortality with an SpO2 target of 88-92% | D | UK-ROX found 35.4% versus 34.9%. |
| Lower 90-day mortality with a PaO2 target of 60 mm Hg | D | HOT-ICU found 42.9% versus 42.4%. |
Cross-check — Codex and Claude
This verdict was drafted by Codex through literature review and source-existence checks, cross-checked through blind grading and adversarial audit, and settled by reapplying the methodology boundary rules. Cases with split grades were resolved through rejudgment.
Evidence Table
| Study | Design | Sample | Funding | Endpoint | Result | Weight |
|---|---|---|---|---|---|---|
| Study 1 | Multicenter pragmatic registry-embedded randomized trial | 1 | UK National Institute for Health and Care Research | 90-day all-cause mortality | 2908/8211 (35.4%) vs 2858/8183 (34.9%), adjusted RD +0.7 points (-0.7 to +2.0) | Largest and most direct mortality trial |
| ICU-ROX Investigators 2020 | Multicenter randomized trial | 951 | Health Research Council of New Zealand | Primary 28-day ventilator-free days; secondary 90- and 180-day mortality | Ventilator-free days 21.3 vs 22.1; 180-day mortality 35.7% vs 34.5% | Indirect because target and primary endpoint differed |
| Study 3 | Multicenter randomized trial | 2,888 | Innovation Fund Denmark and public/nonprofit funders | 90-day all-cause mortality | 618/1441 (42.9%) vs 613/1447 (42.4%), RR 1.02 (0.94-1.11) | Acute hypoxemic respiratory failure trial with different PaO2 targets |
| Study 4 | Cluster-randomized cluster-crossover trial | 1 | US National Heart, Lung, and Blood Institute and others | Ventilator-free days through day 28 | Medians 20, 21, and 21 days; 28-day in-hospital mortality 34.8%, 34.0%, and 33.2% | Not direct replication because it used three targets and a different primary endpoint |
Receipt — 5 References
All 5 cited sources were verified for existence at the original page (as of 2026-08-07).
Martin DS, Gould DW, Shahid T, et al. Conservative Oxygen Therapy in Mechanically Ventilated Critically Ill Adult Patients: The UK-ROX Randomized Clinical Trial. JAMA. 2025;334:398-408. PMID: 40501321. DOI: 10.1001/jama.2025.9663.
checkedICU-ROX Investigators. Conservative Oxygen Therapy during Mechanical Ventilation in the ICU. N Engl J Med. 2020;382:989-998. PMID: 31613432. DOI: 10.1056/NEJMoa1903297.
checkedSchjørring OL, Klitgaard TL, Perner A, et al. Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure. N Engl J Med. 2021;384:1301-1311. PMID: 33471452. DOI: 10.1056/NEJMoa2032510.
checkedSemler MW, Casey JD, Lloyd BD, et al. Oxygen-Saturation Targets for Critically Ill Adults Receiving Mechanical Ventilation. N Engl J Med. 2022;387:1759-1769. PMID: 36278971. DOI: 10.1056/NEJMoa2208415.
checkedBarrot L, Asfar P, Mauny F, et al. Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome. N Engl J Med. 2020;382:999-1008. PMID: 32160661. DOI: 10.1056/NEJMoa1916431.
checkedDraft and rewrite: Codex (AI) · Verification: Codex blind grading and adversarial audit · Final adjudication: Claude
Reviewed and approved: Chamgap Editorial Team · Approval date: 2026-08-07 · Corrections: none
Reviewed and approved: Chamgap Editorial Team · Approval date: 2026-08-07 · Corrections: none
Cite this verdict
[Chamgap] Conservative oxygen target x ICU mortality — Evidence Grade D·34. 5 cited sources checked. Source: https://chamgap.com/en/verdicts/energy/conservative-oxygen-target-icu-mortality/ · CC BY 4.0CC BY 4.0 — free to use with attribution; do not distort grades, numbers, or verdict meaning.
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