Early CPAP versus Surfactant, and Oxygen Saturation Targets

SUPPORT · New England Journal of Medicine · 2010

A factorial trial whose oxygen-target arm changed practice more than its CPAP arm, and not in the direction many expected.

Early CPAP did not significantly reduce death or bronchopulmonary dysplasia compared with intubation and surfactant.

The lower saturation target reduced severe retinopathy of prematurity among survivors.

The lower saturation target was associated with increased mortality.

The oximeters used had a calibration offset that was corrected partway through, complicating interpretation of the achieved ranges.

Achieved saturations overlapped substantially between the two target groups.

The mortality signal was not the primary outcome of that randomisation.

Targeting a lower saturation range to avoid retinopathy carries a mortality trade-off that must be stated explicitly.

Read alongside the NeOProM prospective meta-analysis, which pooled this trial with BOOST-II and COT.