Effect of age on the association between oxygen exposure and mortality in ARDS: a secondary analysis of randomized controlled trials with independent multicenter evaluation
In brief
Higher oxygen exposure tracked with mortality in 4,953 ARDS patients, regardless of age
Across six trials, higher inspired oxygen fractions were linearly associated with mortality in 4,953 patients with acute respiratory distress syndrome, with no evidence that age changed the association. A separate cohort of 559 patients confirmed the pattern, but these analyses show an association, not that oxygen exposure caused deaths; the safest oxygen levels remain uncertain.
- Journal
- Anaesthesia, critical care & pain medicine (Q1)
- Published
- 4 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Konstantinos Gkirgkiris, Michail Georgopoulos, Eleni Papoutsi, Anna Kyriakoudi, Konstantinos Pontikis, Vasiliki Tsolaki, et al.
- PMID
- 42982124
- DOI
- 10.1016/j.accpm.2026.101974
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 8 November 2026): association between FiO2 and mortality linear, independent of age
- Picked for Pulmonary and Respiratory Medicine (top studies of the week, 8 November 2026): Oxygen exposure mortality linear in ARDS
Abstract
BACKGROUND: Fractions of inspired oxygen up to 60% in patients receiving invasive mechanical ventilation are commonly perceived by clinicians as safe, implying a non-linear association between oxygen exposure and mortality. Also, although it seems pathophysiologically plausible that the association between oxygen exposure and mortality may depend on age, relevant evidence in adult patients is lacking. We examined whether the association between fraction of inspired oxygen and mortality a) is non-linear and b) depends on age. METHODS: We performed a secondary analysis of individual patient-level data from six acute respiratory distress syndrome (ARDS) Network and PETAL Network randomized controlled trials ("ARDSNet cohort"). We assessed linearity of the association between fraction of inspired oxygen and mortality along with the effect of age after adjusting for covariates, including partial pressure of arterial oxygen. We tested our findings in an independent multicenter cohort. RESULTS: In the ARDSNet cohort involving 4953 patients with ARDS, we found that the association between fraction of inspired oxygen and mortality was linear and independent of age (p = 0.655 for the interaction between fraction of inspired oxygen and age). In the independent cohort involving 559 patients with ARDS, we confirmed both the linearity of the association between fraction of inspired oxygen and mortality and the lack of effect of age (p = 0.955 for the interaction). CONCLUSION: Data from the two tested multicenter cohorts suggest that the association between fraction of inspired oxygen and mortality in ARDS may be linear and independent of age.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.