Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure

Olav L Schjørring, Thomas L Klitgaard, Anders Perner, Jørn Wetterslev, Theis Lange, Martin Siegemund, Minna Bäcklund, Frederik Keus, Jon H Laake, Matthew Morgan, Katrin M Thormar, Søren A Rosborg, Jannie Bisgaard, Annette E S Erntgaard, Anne-Sofie H Lynnerup, Rasmus L Pedersen, Elena Crescioli, Theis C Gielstrup, Meike T Behzadi, Lone M Poulsen, Stine Estrup, Jens P Laigaard, Cheme Andersen, Camilla B Mortensen, Björn A Brand, Jonathan White, Inge-Lise Jarnvig, Morten H Møller, Lars Quist, Morten H Bestle, Martin Schønemann-Lund, Maj K Kamper, Mathias Hindborg, Alexa Hollinger, Caroline E Gebhard, Núria Zellweger, Christian S Meyhoff, Mathias Hjort, Laura K Bech, Thorbjørn Grøfte, Helle Bundgaard, Lars H M Østergaard, Maria A Thyø, Thomas Hildebrandt, Bülent Uslu, Christoffer G Sølling, Nette Møller-Nielsen, Anne C Brøchner, Morten Borup, Marjatta Okkonen, Willem Dieperink, Ulf G Pedersen, Anne S Andreasen, Lone Buus, Tayyba N Aslam, Robert R Winding, Joerg C Schefold, Stine B Thorup, Susanne A Iversen, Janus Engstrøm, Maj-Brit N Kjær, Bodil S Rasmussen
New England Journal of Medicine 2021 January 20

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 number, NCT03174002.).

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