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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.).
Background:
Patients with acute hypoxemic respiratory failure in the intensive care unit (ICU) are treated with supplemental oxygen, but the benefits and harms of different oxygenation targets are unclear. We hypothesized that using a lower target for partial pressure of arterial oxygen (Pao2) would result in lower mortality than using a higher target.
Methods:
In this multicenter trial, we randomly assigned 2928 adult patients who had recently been admitted to the ICU (≤12 hours before randomization) and who were receiving at least 10 liters of oxygen per minute in an open system or had a fraction of inspired oxygen of at least 0.50 in a closed system to receive oxygen therapy targeting a Pao2 of either 60 mm Hg (lower-oxygenation group) or 90 mm Hg (higher-oxygenation group) for a maximum of 90 days. The primary outcome was death within 90 days.
Results:
At 90 days, 618 of 1441 patients (42.9%) in the lower-oxygenation group and 613 of 1447 patients (42.4%) in the higher-oxygenation group had died (adjusted risk ratio, 1.02; 95% confidence interval, 0.94 to 1.11; P = 0.64). At 90 days, there was no significant between-group difference in the percentage of days that patients were alive without life support or in the percentage of days they were alive after hospital discharge. The percentages of patients who had new episodes of shock, myocardial ischemia, ischemic stroke, or intestinal ischemia were similar in the two groups (P = 0.24).
Conclusions:
Among adult patients with acute hypoxemic respiratory failure in the ICU, a lower oxygenation target did not result in lower mortality than a higher target at 90 days. (Funded by the Innovation Fund Denmark and others; HOT-ICU ClinicalTrials.gov number, NCT03174002.).
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