Comparing restrictive versus liberal oxygen strategies for trauma patients-the TRAUMOX2 trial: protocol for a randomised clinical trial

Josefine Baekgaard*, Tobias Arleth, Volkert Siersma, Jochen Hinkelbein, Sirin Yücetepe, Markus Klimek, Mark G. Van Vledder, Esther M.M. Van Lieshout, Søren Mikkelsen, Stine Thorhauge Zwisler, Mikkel Andersen, Christian Fenger-Eriksen, Dan L. Isbye, Lars S. Rasmussen, Jacob Steinmetz

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Introduction Supplemental oxygen is commonly used in trauma patients, although it may lead to hyperoxaemia that has been associated with pulmonary complications and increased mortality. The primary objective of this trial, TRAUMOX2, is to compare a restrictive versus liberal oxygen strategy the first 8 hours following trauma. Methods and analysis TRAUMOX2 is an investigator-initiated, international, parallel-grouped, superiority, outcome assessor-blinded and analyst-blinded, randomised, controlled, clinical trial. Adult patients with suspected major trauma are randomised to eight hours of a restrictive or liberal oxygen strategy. The restrictive group receives the lowest dosage of oxygen (>21%) that ensures an SpO 2 of 94%. The liberal group receives 12-15 L O 2 /min or FiO 2 =0.6-1.0. The primary outcome is a composite of 30-day mortality and/or development of major respiratory complications (pneumonia and/or acute respiratory distress syndrome). With 710 participants in each arm, we will be able to detect a 33% risk reduction with a restrictive oxygen strategy if the incidence of our primary outcome is 15% in the liberal group. Ethics and dissemination TRAUMOX2 is carried out in accordance with the Helsinki II Declaration. It has been approved by the Danish Committee on Health Research Ethics for the Capital Region (H-21018062) and The Danish Medicines Agency, as well as the Dutch Medical Research Ethics Committee Erasmus MS (NL79921.078.21 and MEC-2021-0932). A website ( is available for updates and study results will be published in an international peer-reviewed scientific journal. Trial registration numbers EudraCT 2021-000556-19; NCT05146700.

Original languageEnglish
Article numbere064047
JournalBMJ Open
Issue number11
Publication statusPublished - 7 Nov 2022

Bibliographical note

Funding Information:
TRAUMOX2 is initiated by a research group of medical doctors in 'Department of Anaesthesia and Trauma Centre, Centre of Head and Orthopaedics, Rigshospitalet, Denmark'. The work presented in this article is supported by Novo Nordisk Foundation grant NNF20OC0063985. In addition, the study is supported by The Lundbeck Foundation through a personal grant to author JB. Drug expenses are covered by the participating centres’ departmental budget. Drug expenses beyond the normal department budget is also be covered by the participating centres.

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