Lower or higher oxygenation targets for acute hypoxemic respiratory failure

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

DOI

  • Olav L. Schjørring, Aalborg University
  • ,
  • Thomas L. Klitgaard, Aalborg University
  • ,
  • Anders Perner, University of Copenhagen
  • ,
  • Jørn Wetterslev, University of Copenhagen
  • ,
  • Theis Lange, University of Copenhagen
  • ,
  • Martin Siegemund, University of Basel
  • ,
  • Minna Bäcklund, University of Southern Denmark
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  • Frederik Keus, University of Groningen
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  • Jon H. Laake, University of Oslo
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  • Matthew Morgan, Cardiff & Vale University Health Board
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  • Katrin M. Thormar, Landspitali University Hospital
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  • Søren A. Rosborg, Aalborg University
  • ,
  • Jannie Bisgaard, Aalborg University
  • ,
  • Annette E.S. Erntgaard, Aalborg University
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  • Anne Sofie H. Lynnerup, Aalborg University
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  • Rasmus L. Pedersen, Aalborg University
  • ,
  • Elena Crescioli, Aalborg University
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  • Theis C. Gielstrup, Aalborg University
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  • Meike T. Behzadi, Aalborg University
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  • Lone M. Poulsen, Sjællands Universitetshospital
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  • Stine Estrup, Sjællands Universitetshospital
  • ,
  • Jens P. Laigaard, Sjællands Universitetshospital
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  • Cheme Andersen, Sjællands Universitetshospital
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  • Camilla B. Mortensen, Sjællands Universitetshospital
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  • Björn A. Brand, University of Copenhagen
  • ,
  • Jonathan White, Copenhagen Trial Unit
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  • Inge Lise Jarnvig, University of Copenhagen
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  • Morten H. Møller, University of Copenhagen
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  • Lars Quist, University of Copenhagen
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  • Morten H. Bestle, University of Copenhagen
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  • Martin Schønemann-Lund, University of Copenhagen
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  • Maj K. Kamper, University of Copenhagen
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  • Mathias Hindborg, University of Copenhagen
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  • Alexa Hollinger, University of Basel
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  • Caroline E. Gebhard, University of Basel
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  • Núria Zellweger, University of Basel
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  • Christian S. Meyhoff, University of Copenhagen
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  • Mathias Hjort, University of Copenhagen
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  • Laura K. Bech, University of Copenhagen
  • ,
  • Thorbjørn Grøfte
  • Helle Bundgaard
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  • Lars H.M. Østergaard, Aarhus University
  • ,
  • Maria A. Thyø
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  • Thomas Hildebrandt, Sjællands Universitetshospital
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  • Bülent Uslu, Sjællands Universitetshospital
  • ,
  • Christoffer G. Sølling
  • Nette Møller-Nielsen, Aarhus University
  • ,
  • Anne C. Brøchner, University of Southern Denmark
  • ,
  • Lone Buus
  • ,
  • Robert R. Winding
  • HOT-ICU Investigators

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.

Original languageEnglish
JournalNew England Journal of Medicine
Volume384
Issue14
Pages (from-to)1301-1311
Number of pages11
ISSN0028-4793
DOIs
Publication statusPublished - Apr 2021

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