A lower oxygenation target for acute hypoxemic respiratory failure does not reduce mortality

April 7, 2021

2 min reading

Source / Discoveries

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Schjørring does not report on the relevant financial statements. Please see the study for all relevant financial disclosures by all other authors.


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According to the results of the HOT-ICU study, for 90 days, patients with acute hypoxemic respiratory failure on ICU who received oxygen therapy with a lower oxygen target did not have a lower mortality than the higher target.

“Our findings suggest the usefulness of conservative oxygen therapy in patients with acute hypoxemic respiratory failure, compared to LOCO results.2 trial, ” Olav L. SchjørringDr. Med., from Department of Anesthesia and Intensive Care at Aalborg University Hospital at Aalborg University in Denmark, and colleagues wrote in The New England Journal of Medicine. “At the same time, the results of our study do not rule out the possibility of clinically significant harm or benefit from a lower oxygenation strategy in this population or in other types of critically ill patients.”

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The HOT-ICU study included 2,928 adults (mean age 70 years; 63.2% of men) who were admitted to the ICU 12 hours or less prior to enrollment and received at least 10 L of oxygen per minute in the open system or had an inspiration oxygen fraction of 0.5 L or more in a closed system. Participants were randomly assigned to oxygen therapy with a target oxygen partial pressure of 60 mm Hg (n = 1,441) or 90 mm Hg (n = 1,447) for 90 days.

The primary outcome was 90-day mortality. During follow – up, 42.9% of patients in the lower oxygenation group died compared to 42.4% of patients in the higher oxygenation group (adjusted RR = 1.02; 95% CI, 0.94-1.11; Str = .64), according to the results.

“It is noticeable that we observed a 90-day mortality rate that was twice as high as assumed based on data previously obtained in five Danish ICUs,” the researchers wrote. “The greater 90-day death in our study could have been due in part to differences in types of admissions.”

There was no significant difference in the percentage of days when patients were alive without life support (group with lower oxygenation, 87.8 compared to the group with higher oxygenation, 84.4) or in the percentage of days after discharge from hospital in 90 days (55 , 6 in 50, respectively), the researchers reported.

The most common serious adverse event experienced in both groups was shock, in 33.9% of patients in the low oxygenation group and 35.8% in the higher oxygenation group. Other serious adverse events such as myocardial ischemia (1% vs. 0.5%), ischemic stroke (1.3% vs. 1.6%), and intestinal ischemia (2.2% vs. 2%) did not differ significantly between lower and higher oxygenation of the group.

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