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