Photo: Dr. Tobias Arleth is the first author of the TRAUMOX2 study, the
world’s first large randomized trial investigating whether high levels of
oxygen benefit trauma patients.
International guidelines recommend that all severely injured patients receive liberal oxygen therapy during the first hours after trauma. However, a new international research project, led by Rigshospitalet, now challenges this recommendation.
Dr. Tobias Arleth, a physician and PhD student from the Department of Anaesthesia, Surgery, and Trauma Center at the Head and Orthopedic Center at Rigshospitalet, explains:
"We investigated whether the recommended liberal oxygen therapy in the initial phase after trauma might potentially do more harm than good. The results are not definitive but suggest that a restrictive oxygen strategy could be a relevant alternative to the current 'one size fits all' recommendation," says Tobias Arleth.
The study, called TRAUMOX2, is the first large-scale, international, randomized controlled trial in the world to explore whether a restrictive oxygen strategy can reduce mortality and/or severe lung complications in trauma patients compared to a liberal strategy.
The findings have been published in the prestigious scientific journal JAMA
Similar Outcomes with Less Oxygen
The study included 1,508 adult trauma patients who were randomized to either a restrictive oxygen strategy targeting an oxygen saturation level of 94% or a liberal oxygen strategy involving high oxygen delivery—either 12-15 liters via mask or 60-100% oxygen via ventilator—during the first eight hours post-trauma. The study was conducted in Denmark, the Netherlands, and Switzerland.
The results showed that 16.1% of patients in the restrictive oxygen group experienced death and/or severe lung complications within 30 days, compared to 16.7% in the liberal oxygen group. This difference was not statistically significant.
However, the researchers noted that one specific lung complication, atelectasis (lung tissue collapse), was less common in the restrictive group than in the liberal group.
Although the study did not demonstrate a clear benefit of the restrictive oxygen strategy, the findings open up an important discussion on oxygen therapy for trauma patients:
"Oxygen is a drug that should be administered based on medical indications. If we can manage with less oxygen, this is generally preferable. But we now need to discuss these results within the scientific community so that professionals in many countries can contribute to the development of future guidelines for oxygen therapy in trauma patients," says Tobias Arleth.
He explains that the research team initiated the study because, over the past decade, there has been growing awareness that excessive supplemental oxygen can be harmful in certain patient groups, such as those with heart attacks or intensive care patients. In these areas, medical professionals have become more restrictive in their use of supplemental oxygen.
For inquiries about the research, Tobias Arleth can be contacted at tobias.arleth@regionh.dk or via LinkedIn: Tobias Arleth on LinkedIn