Oxygenation targets in ICU patients with COVID-19: a post-hoc sub-group analysis of the HOT-ICU trial
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Oxygenation targets in ICU patients with COVID-19 : a post-hoc sub-group analysis of the HOT-ICU trial. / Rasmussen, Bodil S.; Klitgaard, Thomas L.; Perner, Anders; Brand, Björn A.; Hildebrandt, Thomas; Siegemund, Martin; Hollinger, Alexa; Aagaard, Søren R.; Bestle, Morten H.; Marcussen, Klaus V.; Brøchner, Anne C.; Sølling, Christoffer G.; Poulsen, Lone M.; Laake, Jon H.; Aslam, Tayyba N.; Bäcklund, Minna; Okkonen, Marjatta; Morgan, Matthew; Sharman, Mike; Lange, Theis; Wetterslev, Jørn; Schjørring, Olav L.
In: Acta Anaesthesiologica Scandinavica, Vol. 66, No. 1, 2022, p. 76-84.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Oxygenation targets in ICU patients with COVID-19
T2 - a post-hoc sub-group analysis of the HOT-ICU trial
AU - Rasmussen, Bodil S.
AU - Klitgaard, Thomas L.
AU - Perner, Anders
AU - Brand, Björn A.
AU - Hildebrandt, Thomas
AU - Siegemund, Martin
AU - Hollinger, Alexa
AU - Aagaard, Søren R.
AU - Bestle, Morten H.
AU - Marcussen, Klaus V.
AU - Brøchner, Anne C.
AU - Sølling, Christoffer G.
AU - Poulsen, Lone M.
AU - Laake, Jon H.
AU - Aslam, Tayyba N.
AU - Bäcklund, Minna
AU - Okkonen, Marjatta
AU - Morgan, Matthew
AU - Sharman, Mike
AU - Lange, Theis
AU - Wetterslev, Jørn
AU - Schjørring, Olav L.
PY - 2022
Y1 - 2022
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 hours 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 sub-group 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 0.58 - 1.32). Percentage of days alive without life support was significantly higher in the lower oxygenation group (p=0.03). 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 sub-group analysis, and insignificant tests for interaction with the main HOT-ICU trial.
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 hours 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 sub-group 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 0.58 - 1.32). Percentage of days alive without life support was significantly higher in the lower oxygenation group (p=0.03). 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 sub-group analysis, and insignificant tests for interaction with the main HOT-ICU trial.
KW - Intensive Care Units
KW - Oxygen Inhalation Therapy
KW - Randomised Controlled Trial
KW - Respiratory Insufficiency
KW - Severe acute respiratory syndrome coronavirus 2
KW - Intensive Care Units
KW - Oxygen Inhalation Therapy
KW - Randomised Controlled Trial
KW - Respiratory Insufficiency
KW - Severe acute respiratory syndrome coronavirus 2
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 -
ID: 279716830