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Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure
Olav L Schjørring1, Thomas L Klitgaard1, Anders Perner1
1From the Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg University, Aalborg (O.L.S., T.L.K., S.A.R., J.B., A.E.S.E., A.-S.H.L., R.L.P., E.C., T.C.G., M.T.B., B.S.R.), Zealand University Hospital, Køge (L.M.P., S.E., J.P.L., C.A., C.B.M.), Rigshospitalet (A.P., B.A.B., J. Wetterslev, I.-L.J., M.H.M., L.Q., M.-B.N.K.) and the Section of Biostatistics, Department of Public Health (T.L.), University of Copenhagen, Bispebjerg, and Frederiksberg Hospital (C.S.M., M. Hjort, L.K.B.) and the Copenhagen Trial Unit (J. White, J.E.), Copenhagen, Nordsjaellands Hospital, Hillerod (M.H.B., M.S.-L., M.K.K., M. Hindborg), Randers Hospital, Randers (T.G., H.B.), Aarhus University Hospital, Skejby North, Aarhus (L.H.M.Ø., M.A.T.), Zealand University Hospital, Roskilde (T.H., B.U.), Viborg Hospital, Viborg (C.G.S., N.M.-N.), Kolding Hospital, Kolding (A.C.B., M. Bäcklund), Hvidovre Hospital, Hvidovre (U.G.P.), Herlev Hospital, Herlev (A.S.A.), Horsens Hospital, Horsens (L.B.), Herning Hospital, Herning (R.R.W.), Holbæk Hospital, Holbæk (S.B.T.), and Slagelse Hospital, Slagelse (S.A.I.) - all in Denmark; the Department of Intensive Care and Department of Clinical Research, University of Basel, Basel (M.S., A.H., C.E.G., N.Z.), and the Department of Intensive Care, Inselspital, University of Bern, Bern (J.C.S.) - both in Switzerland; the Department of Perioperative, Intensive Care and Pain Medicine, Helsinki University Hospital, Helsinki (M.B., M.O.); the Department of Critical Care, University Medical Center Groningen, Groningen, the Netherlands (F.K., W.D.); the Departments of Anesthesia and Intensive Care and of Clinical Research, Rikshospitalet, Oslo University Hospital, Oslo (J.H.L., T.N.A.); the Department of Intensive Care, Cardiff University Hospital of Wales, Cardiff, United Kingdom (M.M.); and the Department of Anesthesia and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland (K.M.T.).
Lowering oxygen targets for critically ill patients with acute hypoxemic respiratory failure did not reduce 90-day mortality. This study on oxygenation targets in the ICU found no significant difference between lower and higher Pao2 levels.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Clinical Trials
Background:
- Optimal oxygenation targets for patients with acute hypoxemic respiratory failure in the intensive care unit (ICU) remain unclear.
- Supplemental oxygen is standard, but evidence on the benefits and harms of different targets is limited.
Purpose of the Study:
- To investigate whether a lower target for partial pressure of arterial oxygen (Pao2) reduces mortality compared to a higher target in ICU patients with acute hypoxemic respiratory failure.
Main Methods:
- A multicenter trial randomized 2928 adult ICU patients to oxygen therapy targeting a Pao2 of 60 mm Hg (lower-oxygenation group) or 90 mm Hg (higher-oxygenation group).
- The primary outcome was death within 90 days.
- Patients received targeted oxygen for up to 90 days.
Main Results:
- No significant difference in 90-day mortality was observed between the lower-oxygenation group (42.9%) and the higher-oxygenation group (42.4%).
- There were no significant between-group differences in days alive without life support or days alive after discharge.
- Incidence of new shock, myocardial ischemia, ischemic stroke, or intestinal ischemia was similar in both groups.
Conclusions:
- A lower oxygenation target did not result in lower 90-day mortality compared to a higher target in adult ICU patients with acute hypoxemic respiratory failure.
- The findings suggest that current oxygenation targets may not significantly impact mortality in this patient population.
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