Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
08 04 2021
08 04 2021
Historique:
pubmed:
21
1
2021
medline:
23
4
2021
entrez:
20
1
2021
Statut:
ppublish
Résumé
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 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 Pao 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). 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. (Funded by the Innovation Fund Denmark and others; HOT-ICU ClinicalTrials.gov number, NCT03174002.).
Sections du résumé
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
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 Pao
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. (Funded by the Innovation Fund Denmark and others; HOT-ICU ClinicalTrials.gov number, NCT03174002.).
Identifiants
pubmed: 33471452
doi: 10.1056/NEJMoa2032510
doi:
Substances chimiques
Oxygen
S88TT14065
Banques de données
ClinicalTrials.gov
['NCT03174002']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1301-1311Subventions
Organisme : Innovationsfonden
ID : 4108-00011A
Organisme : United States
ID : EMN-2017-00901 and EMN-2019-01055
Pays : United States
Organisme : Det Obelske Familiefond
ID : 27970
Investigateurs
B S Rasmussen
(BS)
M Bäcklund
(M)
F Keus
(F)
T L Klitgaard
(TL)
J H Laake
(JH)
T Lange
(T)
M Morgan
(M)
A Perner
(A)
O L Schjørring
(OL)
M Siegemund
(M)
K M Thormar
(KM)
J Wetterslev
(J)
D De Backer
(D)
J-F Timsit
(JF)
A K Jensen
(AK)
S R Aagaard
(SR)
M T Behzadi
(MT)
A S B Eriksen
(ASB)
A-M G Bunzel
(AG)
K Jensen
(K)
N M Jensen
(NM)
T Jørgensen
(T)
M Levin
(M)
R Moulvad
(R)
H A Mouritsen
(HA)
L S Søndergaard
(LS)
S R Vestergaard
(SR)
L M Poulsen
(LM)
V Khridin
(V)
C B Mortensen
(CB)
J P Laigaard
(JP)
C Andersen
(C)
S Estrup
(S)
N Andersen-Ranberg
(N)
L Nebrich
(L)
J V Jensen
(JV)
H C Boesen
(HC)
M H Møller
(MH)
B A Brand
(BA)
L Russell
(L)
M N Kjær
(MN)
G K Vesterlund
(GK)
J F Degn
(JF)
K R Uhre
(KR)
A L S Lindgaard
(ALS)
T S Meyhoff
(TS)
M Wetterslev
(M)
M W Petersen
(MW)
K L Ellekjær
(KL)
M O Collet
(MO)
B Westergaard
(B)
C O Steensen
(CO)
J Wiis
(J)
M Winther-Olesen
(M)
S T Sigurdsson
(ST)
M H Bestle
(MH)
M Schønemann-Lund
(M)
M K Kamper
(MK)
S Lauritzen
(S)
L Valbjørn
(L)
B Christensen
(B)
J G Hansen
(JG)
K J Nielsen
(KJ)
B Thaarslund
(B)
C S Skandov
(CS)
T S Galle
(TS)
M Ibsen
(M)
L Hein
(L)
T U Skram
(TU)
D F Christensen
(DF)
M Østergaard
(M)
N Wesche
(N)
J Meisner
(J)
A Hollinger
(A)
C Gebhard
(C)
N Zellweger
(N)
D Knobel
(D)
A Zaiser
(A)
P-L Siegemund
(PL)
T Zehnder
(T)
Y Bovey
(Y)
A Blum
(A)
S Reinhold
(S)
C S Meyhoff
(CS)
M Hjort
(M)
L K Bech
(LK)
D B Jensen
(DB)
K M Sørensen
(KM)
P S Rasmussen
(PS)
A R Hjortdal
(AR)
N Reiter
(N)
N E Clausen
(NE)
T Grøfte
(T)
M Rostgaard-Knudsen
(M)
M Vang
(M)
H Bundgaard
(H)
D F Jensen
(DF)
L H M Østergaard
(LHM)
M A Thyø
(MA)
M B Nielsen
(MB)
T Elkmann
(T)
T Hildebrandt
(T)
B Uslu
(B)
C G Sølling
(CG)
N Møller-Nielsen
(N)
S K Pedersen
(SK)
K K Knudsen
(KK)
L Liboriussen
(L)
A C Brøchner
(AC)
T N Haberlandt
(TN)
L S Nielsen
(LS)
M Borup
(M)
C F Elvander
(CF)
N H Bæk
(NH)
K E Fabirkiewicz
(KE)
S H Lundorff
(SH)
J S Nielsen
(JS)
M Pedersen
(M)
J S Knudsen
(JS)
W Dieperink
(W)
H Franke
(H)
H Kranen
(H)
M Kreijtz
(M)
J Wieringa
(J)
M Onrust
(M)
E van den Berg
(E)
U G Pedersen
(UG)
K T Kristiansen
(KT)
J Christensen
(J)
M Okkonen
(M)
M Valkonen
(M)
E Lappi
(E)
S Sutinen
(S)
L Pettilä
(L)
T Suhonen
(T)
J Heinonen
(J)
A S Andreasen
(AS)
H Christensen
(H)
K Skovmand
(K)
H Brix
(H)
H Knudsen
(H)
L Buus
(L)
D Due-Rasmussen
(D)
T N Aslam
(TN)
R Winding
(R)
N Dey
(N)
R L Læbel
(RL)
T B Jensen
(TB)
R Mærkedahl
(R)
A H S Nielsen
(AHS)
L E F Mahler
(LEF)
B G Curtz
(BG)
S Haubjerg
(S)
J C Schefold
(JC)
C A Pfortmueller
(CA)
J Aeby
(J)
D Bertschi
(D)
M Schilling
(M)
F Stoehr
(F)
M Jong
(M)
D Zacharias
(D)
M Roth
(M)
L Fazlija
(L)
M Akaltan
(M)
H-H Bülow
(HH)
S B Thorup
(SB)
A A Aaen
(AA)
S A Iversen
(SA)
H H Sørensen
(HH)
H B Pedersen
(HB)
J Brushøj
(J)
N Foldager
(N)
K Marcussen
(K)
J Karttunen
(J)
I Parviainen
(I)
A Uusaro
(A)
S Bendel
(S)
M Lång
(M)
N Julkunen
(N)
T Nyyssönen
(T)
M Reinikainen
(M)
V Koskela
(V)
S Rahikainen
(S)
E Vaskelainen
(E)
E Halonen
(E)
S Julkunen
(S)
S Rissanen
(S)
A Williams
(A)
E Thomas
(E)
H Hill
(H)
J Brooks
(J)
J Cole
(J)
M Davies
(M)
R Davies
(R)
M Wise
(M)
A Ciubotariu
(A)
M Pawlowicz-Dworzanska
(M)
K A Damgaard
(KA)
M Kruse
(M)
Z Ali
(Z)
D Brønnum
(D)
L Midtgaard
(L)
R M Andersen
(RM)
L N Hansen
(LN)
M Sharman
(M)
A Sukumaran
(A)
R Quayle
(R)
E Connaughton
(E)
R Clark
(R)
K Wylie
(K)
J Bannard-Smith
(J)
K Birchall
(K)
F Pomeroy
(F)
H M Betsch
(HM)
L S Johansen
(LS)
N K Schønemann
(NK)
A Pulkkinen
(A)
R Laru-Sompa
(R)
S Tolmunen
(S)
J Hartikainen
(J)
C Lynch
(C)
L Jones
(L)
B Deacon
(B)
L Roche
(L)
K Turner
(K)
J Grönlund
(J)
R Takala
(R)
J Heiro
(J)
M Järvisalo
(M)
W Siirala
(W)
O Inkinen
(O)
M Valtonen
(M)
O Arola
(O)
R Laitio
(R)
J Kauppinen
(J)
S Kentala
(S)
E Loikas
(E)
P Haltia
(P)
A Joseph
(A)
A Swain
(A)
R Burden
(R)
M Grout
(M)
T O'Brien
(T)
L Balshaw
(L)
M Danha
(M)
A Jose
(A)
S Jones
(S)
E Morino
(E)
L Mumelj
(L)
M I Sigurdsson
(MI)
O Hoiting
(O)
M Peters
(M)
E Rengers
(E)
A Prinssen
(A)
M Evers
(M)
P D G Alexander
(PDG)
L Ward
(L)
C Bowyer
(C)
A Walden
(A)
N Jacques
(N)
P Bhachu
(P)
Commentaires et corrections
Type : CommentIn
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Informations de copyright
Copyright © 2021 Massachusetts Medical Society.