Lower oxygenation target does not reduce mortality in acute hypoxemic respiratory failure: NEJM
Denmark: A lower oxygenation target in patients with acute hypoxemic respiratory failure in the ICU did not result in lower mortality versus higher target at 90 days, finds a recent study in the New England Journal of Medicine.
Acute hypoxemic respiratory failure patients in the intensive care unit (ICU) are treated with supplemental oxygen but there is no clarity on the benefits and harms of different oxygenation targets. Olav L Schjørring, the department of anesthesia and intensive care at Aalborg University Hospital at Aalborg University in Denmark, and colleagues hypothesized that using a lower target for partial pressure of arterial oxygen (Pao2) would result in lower mortality than using a higher target.
The researchers conducted a multicenter trial which included 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. They were randomly assigned 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.
Key findings of the study include:
- 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).
- 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.
"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," wrote the authors.
The study titled, "Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure," is published in the New England Journal of Medicine.