Individualized Inspired Oxygen Fraction Titration During Lung Surgery (iOXY-LUNG) (iOXY-LUNG)

November 4, 2026 updated by: Juan Wei, Shanghai Pulmonary Hospital, Shanghai, China

Individualized Inspired Oxygen Titration Versus Pure Oxygen During Lung Surgery (iOXY-LUNG): a Randomized Clinical Trial

The goal of this clinical trial is to determine whether individualized oxygen adjustment during lung surgery lowers the risk of major complications. The study will include adults undergoing planned surgery on one lung that requires more than one hour of one-lung ventilation. One-lung ventilation means that only one lung is ventilated during part of the operation.

The main question is:

Does individualized oxygen adjustment, compared with continuous 100% oxygen, lower the risk of death or major complications within 30 days after surgery?

Researchers will enroll 628 participants at three hospitals in China. Participants will be randomly assigned to two groups:

  • Individualized inspired oxygen titration group: The anesthesiologist will adjust the oxygen concentration according to blood oxygen saturation, measured continuously using a pulse oximeter.
  • Pure oxygen group: The anesthesiologist will maintain 100% oxygen from the start of general anesthesia until removal of the tracheal tube.

Both groups will receive 100% oxygen before one-lung ventilation begins. In the individualized group, oxygen adjustment will continue after ventilation of both lungs resumes. Before removal of the tracheal tube, the anesthesiologist may raise the oxygen concentration for safety. Both groups will receive treatment if blood oxygen levels become too low.

Researchers will assess participants during hospitalization and through 30 days after surgery. Follow-up after discharge will take place by telephone or outpatient assessment. Researchers will compare deaths and major complications affecting the lungs, heart, brain, or kidneys. They will also assess recovery and safety.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

628

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • China
      • Shanghai, China, 200433
    • Anhui
      • Hefei, Anhui, China, 230001
        • Anhui Provincial Cancer Hospital
        • Contact:
    • Jiangsu
      • Nanjing, Jiangsu, China, 210003

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 100 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Able and willing to provide written informed consent.
  • Age 18 years or older.
  • Scheduled for elective unilateral lung surgery requiring one-lung ventilation, with an anticipated one-lung ventilation duration of more than 1 hour.
  • American Society of Anesthesiologists (ASA) physical status I-III.

Exclusion Criteria:

  • Pregnancy or lactation.
  • History of thoracic surgery.
  • New York Heart Association class III-IV heart failure or Canadian Cardiovascular Society class III-IV coronary artery disease.
  • Acute cardiovascular or cerebrovascular disease within the preceding 6 months or renal insufficiency requiring dialysis.
  • Intracranial injury or tumor.
  • Psychiatric illness, cognitive impairment, communication or language difficulties, or other circumstances expected to prevent follow-up or data collection.
  • Participation in another interventional trial.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Individualized inspired oxygen fraction titration group

Participants will receive individualized inspired oxygen titration from OLV beginning
Other: Individualized inspired oxygen fraction titration

FiO2 will be 1.0 from anesthesia induction until one-lung ventilation begins. Thereafter, FiO2 will be titrated in steps of 0.05 within 0.4-1.0 to identify the lowest concentration maintaining SpO2 ≥ 92%. At SpO2 of 90%-91%, downward titration will stop and FiO2 will be increased. SpO2 below 90% will trigger the prespecified hypoxemia rescue protocol. Titration may resume once oxygenation recovers and stabilizes, as judged by the attending anesthesiologist. The same strategy will continue after two-lung ventilation resumes. Before extubation, FiO2 may be increased for oxygen reserve.
Active Comparator: Pure oxygen group

The fraction of inspired oxygen (FiO2) will be maintained at 1.0 from anesthesia induction until tracheal extubation.
Other: Continuous ventilation with 100% oxygen

FiO2 will be maintained at 1.0 from anesthesia induction until tracheal extubation, including during one-lung ventilation and after two-lung ventilation resumes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Proportion of participants developing one or more major adverse events (MAEs)
Time Frame: The first 30 postoperative days

all-cause death; postoperative pulmonary complications (pneumonia; ARDS; atelectasis; respiratory failure; pulmonary embolism; pneumothorax on the nonoperated side); cardiac events (new-onset atrial fibrillation or flutter, ventricular tachycardia or ventricular fibrillation requiring treatment; myocardial infarction; heart failure); neurological complications (stroke, transient ischemic attack, delirium); acute kidney injury defined as postoperative creatinine level at least doubled from the preoperative level or kidney replacement therapy.
The first 30 postoperative days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Length of hospital stay
Time Frame: From the day of surgery until the day of discharge, up to day 90
From the day of surgery until the day of discharge, up to day 90
Duration of chest tube drainage
Time Frame: Through study completion, an average of 3 days
Through study completion, an average of 3 days
Reintubation
Time Frame: The first 30 postoperative days

Proportion of participants requiring tracheal reintubation after initial postoperative extubation
The first 30 postoperative days
Hospital readmission
Time Frame: The first 30 postoperative days

Proportion of participants readmitted to a hospital after discharge from the index hospitalization and within 30 days after surgery.
The first 30 postoperative days
Sepsis
Time Frame: The first 30 postoperative days

Proportion of participants developing sepsis, defined according to Sepsis-3
The first 30 postoperative days
Surgical site infection
Time Frame: The first 30 postoperative days

Proportion of participants developing surgical site infection
The first 30 postoperative days

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Severe hypoxemia
Time Frame: During surgery

Defined as peripheral oxygen saturation (SpO2) ≤85% for at least 10 seconds
During surgery
Rescue measures for hypoxemia
Time Frame: During surgery

Proportion of participants receiving prespecified rescue measure for intraoperative hypoxemia (SpO2 below 90%)
During surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Shanghai Pulmonary Hospital, Shanghai, China

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

December 20, 2026

Primary Completion (Estimated)

January 31, 2028

Study Completion (Estimated)

March 1, 2028

Study Registration Dates

First Submitted

October 30, 2026

First Submitted That Met QC Criteria

November 4, 2026

First Posted (Actual)

November 5, 2026

Study Record Updates

Last Update Posted (Actual)

November 5, 2026

Last Update Submitted That Met QC Criteria

November 4, 2026

Last Verified

November 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2025LY11105

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Deidentified individual participant data underlying the published study results will be available to qualified researchers upon reasonable request. Sharing will be subject to review of the proposed research, applicable ethical approvals, institutional requirements, and data protection requirements. Individual participant data will not be publicly accessible.

IPD Sharing Time Frame

Requests will be considered beginning 6 months after publication of the main study results.

IPD Sharing Access Criteria

Researchers should submit a methodologically sound research proposal and analysis plan to the corresponding author. Requests will be reviewed by the study leadership team. Access to the minimum necessary deidentified data and supporting documents will require approval of the proposal, any necessary ethical and institutional approvals, and a signed data use agreement.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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