Lower versus higher oxygenation targets in hypoxaemic ICU patients after cardiac arrest
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Lower versus higher oxygenation targets in hypoxaemic ICU patients after cardiac arrest. / Crescioli, Elena; Lass Klitgaard, Thomas; Perner, Anders; Lilleholt Schjørring, Olav; Steen Rasmussen, Bodil.
In: Resuscitation, Vol. 188, 109838, 2023.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Lower versus higher oxygenation targets in hypoxaemic ICU patients after cardiac arrest
AU - Crescioli, Elena
AU - Lass Klitgaard, Thomas
AU - Perner, Anders
AU - Lilleholt Schjørring, Olav
AU - Steen Rasmussen, Bodil
N1 - Publisher Copyright: © 2023 The Author(s)
PY - 2023
Y1 - 2023
N2 - Aim: To investigate the effects of lower versus higher oxygenation targets in adult intensive care unit (ICU) patients with hypoxaemic respiratory failure after cardiac arrest. Methods: Subgroup analysis of the international Handling Oxygenation Targets in the ICU (HOT-ICU) trial which randomised 2928 adults with acute hypoxaemia to targets of arterial oxygenation of 8 kPa or 12 kPa in the ICU for up to 90 days. Here, we report all outcomes up to one year in the subgroup of patients enrolled after cardiac arrest. Results: The HOT-ICU trial included 335 patients after cardiac arrest: 149 in the lower-oxygenation group and 186 in the higher-oxygenation group. At 90 days, 96/147 patients (65.3%) in the lower-oxygenation group and 111/185 patients (60.0%) in the higher-oxygenation group had died (adjusted relative risk (RR) 1.09, 95% confidence interval (CI) 0.92–1.28, p = 0.32); similar results were found at one year (adjusted RR 1.05, 95% CI 0.90–1.21, p = 0.53). Serious adverse events (SAEs) in the ICU occurred in 23% of patients in the lower-oxygenation group and 38% in the higher-oxygenation group (adjusted RR 0.61, 95% CI 0.43–0.86, p = 0.005); the difference was mainly due to more new episodes of shock in the higher-oxygenation group. No statistically significant differences were observed in other secondary outcomes. Conclusion: A lower oxygenation target in adult ICU patients with hypoxaemic respiratory failure after cardiac arrest did not result in lower mortality, but fewer SAEs occurred in this group compared to the higher-oxygenation group. All analyses are exploratory only, large-scale trials are needed for confirmation. Clinical Trial Registry: Clinicaltrials.gov number NCT03174002 (registered May 30, 2017); EudraCT 2017-000632-34 (registered February 14, 2017).
AB - Aim: To investigate the effects of lower versus higher oxygenation targets in adult intensive care unit (ICU) patients with hypoxaemic respiratory failure after cardiac arrest. Methods: Subgroup analysis of the international Handling Oxygenation Targets in the ICU (HOT-ICU) trial which randomised 2928 adults with acute hypoxaemia to targets of arterial oxygenation of 8 kPa or 12 kPa in the ICU for up to 90 days. Here, we report all outcomes up to one year in the subgroup of patients enrolled after cardiac arrest. Results: The HOT-ICU trial included 335 patients after cardiac arrest: 149 in the lower-oxygenation group and 186 in the higher-oxygenation group. At 90 days, 96/147 patients (65.3%) in the lower-oxygenation group and 111/185 patients (60.0%) in the higher-oxygenation group had died (adjusted relative risk (RR) 1.09, 95% confidence interval (CI) 0.92–1.28, p = 0.32); similar results were found at one year (adjusted RR 1.05, 95% CI 0.90–1.21, p = 0.53). Serious adverse events (SAEs) in the ICU occurred in 23% of patients in the lower-oxygenation group and 38% in the higher-oxygenation group (adjusted RR 0.61, 95% CI 0.43–0.86, p = 0.005); the difference was mainly due to more new episodes of shock in the higher-oxygenation group. No statistically significant differences were observed in other secondary outcomes. Conclusion: A lower oxygenation target in adult ICU patients with hypoxaemic respiratory failure after cardiac arrest did not result in lower mortality, but fewer SAEs occurred in this group compared to the higher-oxygenation group. All analyses are exploratory only, large-scale trials are needed for confirmation. Clinical Trial Registry: Clinicaltrials.gov number NCT03174002 (registered May 30, 2017); EudraCT 2017-000632-34 (registered February 14, 2017).
KW - Intensive care units
KW - Mortality
KW - Oxygen Inhalation Therapy
KW - Post-Cardiac Arrest Syndrome
KW - Quality of life
KW - Randomized Controlled Trial
U2 - 10.1016/j.resuscitation.2023.109838
DO - 10.1016/j.resuscitation.2023.109838
M3 - Journal article
C2 - 37196799
AN - SCOPUS:85160085484
VL - 188
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
M1 - 109838
ER -
ID: 366001178