Oxygenation targets in ICU patients with COVID-19: a post-hoc sub-group analysis of the HOT-ICU trial

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  • Bodil S. Rasmussen
  • Thomas L. Klitgaard
  • Björn A. Brand
  • Thomas Hildebrandt
  • Martin Siegemund
  • Alexa Hollinger
  • Søren R. Aagaard
  • Anne C. Brøchner
  • Christoffer G. Sølling
  • Lone M. Poulsen
  • Jon H. Laake
  • Tayyba N. Aslam
  • Minna Bäcklund
  • Marjatta Okkonen
  • Matthew Morgan
  • Mike Sharman
  • Jørn Wetterslev
  • Olav L. Schjørring
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.
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.
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.
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.
Original languageEnglish
JournalActa Anaesthesiologica Scandinavica
Issue number1
Pages (from-to)76-84
Number of pages9
Publication statusPublished - 2022

    Research areas

  • Intensive Care Units, Oxygen Inhalation Therapy, Randomised Controlled Trial, Respiratory Insufficiency, Severe acute respiratory syndrome coronavirus 2

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