Oxygenation Targets and Long-Term Cognitive and Pulmonary Functions in Hypoxemic Respiratory Failure: A Clinical
Elena Crescioli1, Thomas L Klitgaard1, Jens Ø Riis2
1Department of Anesthesia and Intensive Care.
Rationale:
In ICU patients, lower oxygenation targets may impair long-term cognitive function, whereas higher targets may impair long-term pulmonary function.
Objectives:
We sought to assess the effects of a PaO2 target of 60 versus 90 mm Hg on 1-year cognitive and pulmonary functions in ICU survivors of acute hypoxemic respiratory failure.
Methods:
A total of 3,654 patients were randomized in the Handling Oxygenation Targets in the ICU and the Handling Oxygenation Targets in COVID-19 trials: 1,916 (52.4%) survived at 1 year, of which 1,244 (64.9%) were eligible. We assessed two preplanned 1-year outcomes: cognitive function, measured using the global score of the Repeatable Battery for the Assessment of Neuropsychological Status, and pulmonary function, evaluated as the percentage of predicted DlCO.
Measurements And Main Results:
A total of 417/1,244 (33.5%) eligible survivors were included, representing 11.4% of the original trial population. The Global Repeatable Battery for the Assessment of Neuropsychological Status score was obtained from 187 survivors in the lower oxygenation group (mean = 78; SD = 19) and 188 in the higher oxygenation group (mean = 76; SD = 21); adjusted mean difference = 2 (95% confidence interval = -2 to 6). DlCO was measured in 192 survivors in the lower oxygenation group (mean = 68%; SD = 22) and 195 in the higher oxygenation group (mean = 73%; SD = 25); adjusted mean difference = -5 percentage points (95% CI = -9 to -1).
Conclusions:
A PaO2 target of 60 versus 90 mm Hg appeared to result in similar cognitive impairment but might reduce pulmonary diffusion capacity in ICU survivors of hypoxemic respiratory failure included in this 1-year follow-up.Clinical trial registered with www.
Clinicaltrials:
gov (NCT03174002 and NCT04425031).
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