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General medicine
Increased risk of mortality with liberal oxygen therapy compared with conservative oxygen therapy in critically ill adults
  1. Richard Beasley,
  2. Diane Mackle
  1. Medical Research Institute of New Zealand, Wellington, New Zealand
  1. Correspondence to Professor Richard Beasley, Medical Research Institute of New Zealand, Wellington 6242, New Zealand; richard.beasley{at}

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Commentary on: Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 2018; 391:1693–1705. 


Oxygen is one of the most commonly used drugs in acute medicine, yet its prescription and administration in clinical practice is poor.1 The recognition that not only hypoxaemia, but also high FiO2 and hyperoxaemia pose potential avoidable risks to patients, has led to the concept of administering oxygen only if necessary to relieve hypoxaemia, but at an FiO2 that does not lead to hyperoxaemia.2 In the antipodes, this management paradigm has been colloquially referred to as ‘swimming between the flags’, in which oxygen is administered to keep the arterial oxygen saturation within a prespecified target range.3 The efficacy of this approach was demonstrated …

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  • Competing interests RB is the senior author of the Thoracic Society of Australia and New Zealand Adult Oxygen Guidelines Group.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.