Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure

HOT-ICU Investigators; Olav L. Schjorring; Thomas L. Klitgaard; Anders Perner; Jorn Wetterslev; Theis Lange; Martin Siegemund; Minna Backlund; Frederik Keus; Jon H. Laake; Matthew Morgan; Katrin M. Thormar; Soren 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; Bjorn A. Brand; Jonathan White; Inge-Lise Jarnvig; Morten H. Moller; Lars Quist; Morten H. Bestle; Martin Schonemann-Lund; Maj K. Kamper; Mathias Hindborg; Alexa Hollinger; Caroline E. Gebhard; Nuria Zellweger; Christian S. Meyhoff; Mathias Hjort; Laura K. Bech; Thorbjorn Grofte; Helle Bundgaard; Lars H. M. Ostergaard; Maria A. Thyo; Thomas Hildebrandt; Bulent Uslu; Christoffer G. Solling; Nette Moller-Nielsen; Anne C. Brochner; Morten Borup; Willem Dieperink

doi:10.1056/NEJMoa2032510

Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure

HOT-ICU Investigators, Olav L. Schjorring, Thomas L. Klitgaard, Anders Perner, Jorn Wetterslev, Theis Lange, Martin Siegemund, Minna Backlund, Frederik Keus, Jon H. Laake, Matthew Morgan, Katrin M. Thormar, Soren A. Rosborg, Jannie Bisgaard, Annette E. S. Erntgaard, Anne-Sofie H. Lynnerup, Rasmus L. Pedersen, Elena Crescioli, Theis C. Gielstrup, Meike T. BehzadiLone M. Poulsen, Stine Estrup, Jens P. Laigaard, Cheme Andersen, Camilla B. Mortensen, Bjorn A. Brand, Jonathan White, Inge-Lise Jarnvig, Morten H. Moller, Lars Quist, Morten H. Bestle, Martin Schonemann-Lund, Maj K. Kamper, Mathias Hindborg, Alexa Hollinger, Caroline E. Gebhard, Nuria Zellweger, Christian S. Meyhoff, Mathias Hjort, Laura K. Bech, Thorbjorn Grofte, Helle Bundgaard, Lars H. M. Ostergaard, Maria A. Thyo, Thomas Hildebrandt, Bulent Uslu, Christoffer G. Solling, Nette Moller-Nielsen, Anne C. Brochner, Morten Borup, Willem Dieperink

Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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 (Pao(2)) 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 (

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.

Original language	English
Pages (from-to)	1301-1311
Number of pages	11
Journal	New England Journal of Medicine
Volume	384
Issue number	14
Early online date	2021
DOIs	https://doi.org/10.1056/NEJMoa2032510
Publication status	Published - 8-Apr-2021

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Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory FailureFinal publisher's version, 647 KBLicence: Taverne

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HOT-ICU Investigators, Schjorring, O. L., Klitgaard, T. L., Perner, A., Wetterslev, J., Lange, T., Siegemund, M., Backlund, M., Keus, F., Laake, J. H., Morgan, M., Thormar, K. M., Rosborg, S. A., Bisgaard, J., Erntgaard, A. E. S., Lynnerup, A.-S. H., Pedersen, R. L., Crescioli, E., Gielstrup, T. C., ... Dieperink, W. (2021). Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure. New England Journal of Medicine, 384(14), 1301-1311. https://doi.org/10.1056/NEJMoa2032510

@article{247952e89b9a44e59dba033e64cef695,

title = "Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure",

abstract = "BACKGROUNDPatients 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 (Pao(2)) would result in lower mortality than using a higher target.METHODSIn this multicenter trial, we randomly assigned 2928 adult patients who had recently been admitted to the ICU (RESULTSAt 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).CONCLUSIONSAmong 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.",

author = "{HOT-ICU Investigators} and Schjorring, {Olav L.} and Klitgaard, {Thomas L.} and Anders Perner and Jorn Wetterslev and Theis Lange and Martin Siegemund and Minna Backlund and Frederik Keus and Laake, {Jon H.} and Matthew Morgan and Thormar, {Katrin M.} and Rosborg, {Soren A.} and Jannie Bisgaard and Erntgaard, {Annette E. S.} and Lynnerup, {Anne-Sofie H.} and Pedersen, {Rasmus L.} and Elena Crescioli and Gielstrup, {Theis C.} and Behzadi, {Meike T.} and Poulsen, {Lone M.} and Stine Estrup and Laigaard, {Jens P.} and Cheme Andersen and Mortensen, {Camilla B.} and Brand, {Bjorn A.} and Jonathan White and Inge-Lise Jarnvig and Moller, {Morten H.} and Lars Quist and Bestle, {Morten H.} and Martin Schonemann-Lund and Kamper, {Maj K.} and Mathias Hindborg and Alexa Hollinger and Gebhard, {Caroline E.} and Nuria Zellweger and Meyhoff, {Christian S.} and Mathias Hjort and Bech, {Laura K.} and Thorbjorn Grofte and Helle Bundgaard and Ostergaard, {Lars H. M.} and Thyo, {Maria A.} and Thomas Hildebrandt and Bulent Uslu and Solling, {Christoffer G.} and Nette Moller-Nielsen and Brochner, {Anne C.} and Morten Borup and Willem Dieperink",

note = "Copyright {\textcopyright} 2021 Massachusetts Medical Society.",

year = "2021",

month = apr,

day = "8",

doi = "10.1056/NEJMoa2032510",

language = "English",

volume = "384",

pages = "1301--1311",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "MASSACHUSETTS MEDICAL SOC",

number = "14",

}

HOT-ICU Investigators, Schjorring, OL, Klitgaard, TL, Perner, A, Wetterslev, J, Lange, T, Siegemund, M, Backlund, M, Keus, F, Laake, JH, Morgan, M, Thormar, KM, Rosborg, SA, Bisgaard, J, Erntgaard, AES, Lynnerup, A-SH, Pedersen, RL, Crescioli, E, Gielstrup, TC, Behzadi, MT, Poulsen, LM, Estrup, S, Laigaard, JP, Andersen, C, Mortensen, CB, Brand, BA, White, J, Jarnvig, I-L, Moller, MH, Quist, L, Bestle, MH, Schonemann-Lund, M, Kamper, MK, Hindborg, M, Hollinger, A, Gebhard, CE, Zellweger, N, Meyhoff, CS, Hjort, M, Bech, LK, Grofte, T, Bundgaard, H, Ostergaard, LHM, Thyo, MA, Hildebrandt, T, Uslu, B, Solling, CG, Moller-Nielsen, N, Brochner, AC, Borup, M & Dieperink, W 2021, 'Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure', New England Journal of Medicine, vol. 384, no. 14, pp. 1301-1311. https://doi.org/10.1056/NEJMoa2032510

TY - JOUR

T1 - Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure

AU - HOT-ICU Investigators

AU - Schjorring, Olav L.

AU - Klitgaard, Thomas L.

AU - Perner, Anders

AU - Wetterslev, Jorn

AU - Lange, Theis

AU - Siegemund, Martin

AU - Backlund, Minna

AU - Keus, Frederik

AU - Laake, Jon H.

AU - Morgan, Matthew

AU - Thormar, Katrin M.

AU - Rosborg, Soren A.

AU - Bisgaard, Jannie

AU - Erntgaard, Annette E. S.

AU - Lynnerup, Anne-Sofie H.

AU - Pedersen, Rasmus L.

AU - Crescioli, Elena

AU - Gielstrup, Theis C.

AU - Behzadi, Meike T.

AU - Poulsen, Lone M.

AU - Estrup, Stine

AU - Laigaard, Jens P.

AU - Andersen, Cheme

AU - Mortensen, Camilla B.

AU - Brand, Bjorn A.

AU - White, Jonathan

AU - Jarnvig, Inge-Lise

AU - Moller, Morten H.

AU - Quist, Lars

AU - Bestle, Morten H.

AU - Schonemann-Lund, Martin

AU - Kamper, Maj K.

AU - Hindborg, Mathias

AU - Hollinger, Alexa

AU - Gebhard, Caroline E.

AU - Zellweger, Nuria

AU - Meyhoff, Christian S.

AU - Hjort, Mathias

AU - Bech, Laura K.

AU - Grofte, Thorbjorn

AU - Bundgaard, Helle

AU - Ostergaard, Lars H. M.

AU - Thyo, Maria A.

AU - Hildebrandt, Thomas

AU - Uslu, Bulent

AU - Solling, Christoffer G.

AU - Moller-Nielsen, Nette

AU - Brochner, Anne C.

AU - Borup, Morten

AU - Dieperink, Willem

PY - 2021/4/8

Y1 - 2021/4/8

N2 - BACKGROUNDPatients 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 (Pao(2)) would result in lower mortality than using a higher target.METHODSIn this multicenter trial, we randomly assigned 2928 adult patients who had recently been admitted to the ICU (RESULTSAt 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).CONCLUSIONSAmong 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.

AB - BACKGROUNDPatients 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 (Pao(2)) would result in lower mortality than using a higher target.METHODSIn this multicenter trial, we randomly assigned 2928 adult patients who had recently been admitted to the ICU (RESULTSAt 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).CONCLUSIONSAmong 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.

U2 - 10.1056/NEJMoa2032510

DO - 10.1056/NEJMoa2032510

M3 - Article

C2 - 33471452

SN - 0028-4793

VL - 384

SP - 1301

EP - 1311

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 14

ER -

Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure

Abstract

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