TY - JOUR
T1 - Oxygenation targets in ICU patients with COVID-19: a post-hoc sub-group analysis of the HOT-ICU trial.
AU - Rasmussen, Bodil Steen
AU - Lass Klitgaard, Thomas
AU - Perner, Anders
AU - Brandt, Björn Anders
AU - Hildebrandt, Thomas
AU - Siegemund, Martin
AU - Hollinger, Alexa
AU - Aagaard, Søren Rosborg
AU - Heiberg Bestle, Morten
AU - Marcussen, Klaus Vennick
AU - Craveiro Brøchner, Anne
AU - Sølling, Christoffer Grant
AU - Musaeus Poulsen, Lone
AU - Laake, Jon Henrik
AU - Aslam, Tayyba Naz
AU - Bäcklund, Minna
AU - Okkonen, Marjatta
AU - Morgan, Matthew
AU - Sharman, Mike
AU - Lange, Theis
AU - Wetterslev, Jørn
AU - Schjørring, Olav Lilleholt
N1 - © 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
PY - 2022/1
Y1 - 2022/1
N2 - Background: Supplemental oxygen is the key intervention for severe and critical COVID-19 patients. With the unstable supplies of oxygen in many countries, it is important to define the lowest safe dosage. Methods: In spring 2020, 110 COVID-19 patients were enrolled as part of the Handling Oxygenation Targets in the ICU trial (HOT-ICU). Patients were allocated within 12 h of ICU admission. Oxygen therapy was titrated to a partial pressure of arterial oxygen (PaO2) of 8 kPa (lower oxygenation group) or a PaO2 of 12 kPa (higher oxygenation group) during ICU stay up to 90 days. We report key outcomes at 90 days for the subgroup of COVID-19 patients. Results: At 90 days, 22 of 54 patients (40.7%) in the lower oxygenation group and 23 of 55 patients (41.8%) in the higher oxygenation group had died (adjusted risk ratio: 0.87; 95% confidence interval, 0.58–1.32). The percentage of days alive without life support was significantly higher in the lower oxygenation group (p = 0.03). The numbers of severe ischemic events were low with no difference between the two groups. Proning and inhaled vasodilators were used more frequently, and the positive end-expiratory pressure was higher in the higher oxygenation group. Tests for interactions with the results of the remaining HOT-ICU population were insignificant. Conclusions: Targeting a PaO2 of 8 kPa may be beneficial in ICU patients with COVID-19. These results come with uncertainty due to the low number of patients in this unplanned subgroup analysis, and insignificant tests for interaction with the main HOT-ICU trial. Trial registration number: ClinicalTrials.gov number, NCT03174002. Date of registration: June 2, 2017.
AB - Background: Supplemental oxygen is the key intervention for severe and critical COVID-19 patients. With the unstable supplies of oxygen in many countries, it is important to define the lowest safe dosage. Methods: In spring 2020, 110 COVID-19 patients were enrolled as part of the Handling Oxygenation Targets in the ICU trial (HOT-ICU). Patients were allocated within 12 h of ICU admission. Oxygen therapy was titrated to a partial pressure of arterial oxygen (PaO2) of 8 kPa (lower oxygenation group) or a PaO2 of 12 kPa (higher oxygenation group) during ICU stay up to 90 days. We report key outcomes at 90 days for the subgroup of COVID-19 patients. Results: At 90 days, 22 of 54 patients (40.7%) in the lower oxygenation group and 23 of 55 patients (41.8%) in the higher oxygenation group had died (adjusted risk ratio: 0.87; 95% confidence interval, 0.58–1.32). The percentage of days alive without life support was significantly higher in the lower oxygenation group (p = 0.03). The numbers of severe ischemic events were low with no difference between the two groups. Proning and inhaled vasodilators were used more frequently, and the positive end-expiratory pressure was higher in the higher oxygenation group. Tests for interactions with the results of the remaining HOT-ICU population were insignificant. Conclusions: Targeting a PaO2 of 8 kPa may be beneficial in ICU patients with COVID-19. These results come with uncertainty due to the low number of patients in this unplanned subgroup analysis, and insignificant tests for interaction with the main HOT-ICU trial. Trial registration number: ClinicalTrials.gov number, NCT03174002. Date of registration: June 2, 2017.
KW - intensive care units
KW - oxygen inhalation therapy
KW - randomized controlled trial
KW - respiratory insufficiency
KW - severe acute respiratory syndrome coronavirus 2
KW - COVID-19
KW - Intensive Care Units
KW - SARS-CoV-2
KW - Humans
KW - Lung
KW - Oxygen Inhalation Therapy
KW - Respiration, Artificial
UR - http://www.scopus.com/inward/record.url?scp=85115101315&partnerID=8YFLogxK
U2 - 10.1111/aas.13977
DO - 10.1111/aas.13977
M3 - Journal article
C2 - 34425016
VL - 66
SP - 76
EP - 84
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
IS - 1
ER -