Multicenter Implementation Trial of Targeted Normoxia Strategy to Define Oxygen Requirements for Combat Casualty Care

Background: Oxygen therapy has undisputed importance in combat casualty care to treat/prevent morbidity associated with hypoxia. However, generous supplemental oxygen is routine, and often results in hyperoxia. Emerging evidence indicates that even modest hyperoxia can increases morbidity/mortality, however limited evidence exists specifically for trauma patients. In addition, oxygen is a limited resource that is challenging to obtain in austere settings eg, prolonged field care and enroute care, requiring substantial resources, space, weight and logistics to procure. Therefore, it is critical to determine oxygen titration goals for combat injured to optimize care by reducing harm associated with hypoxia and hyperoxia and to conserve limited oxygen supply. Preliminary Data: From our prior USSOCOM-funded work, we recently published a trauma-specific systematic literature review of oxygen targets along with an expert consensus of military and civilian experts in trauma surgery, emergency medicine, critical care, and military operational medicine. Our findings demonstrate remarkable potential to reduce oxygen requirements by implementing a consensus- based definition of normoxia, based on a goal oxygen saturation of 90-96 deg 10. We also pilot-tested the targeted normoxia intervention to demonstrate feasibility and safety for the proposed multicenter implementation trial. Objective/Hypothesis: Our objective is to determine the feasibility, safety, and effectiveness of tbc targeted normoxia approach to conserve oxygen and improve clinical outcomes in critically injured patients. We hypothesize that more targeted use of oxygen therapy, to limit exposure to both hyperoxia and hypoxia, will safely reduce the needs for concentrated oxygen in the deployed, combat setting. Specific Aims: We will conduct a prospective multicenter clinical trial, achieving the following aims: Aim 1. Measure the impact of targeted normoxia on oxygen requirements in critically injured patients.