HOT-ICU Trial

NEJM

April 8, 2021

Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure.

Summarized by: 

Mazen Kherallah

What was the research question?

  • ·Does lower target for partial pressure of arterial oxygen (Pao2) improve mortality compared to higher target in patients with acute hypoxemic respiratory failure in the intensive care unit?


How did they do it?

  • A multicenter trial randomized trial in Europe with 1:1 assignment.

  • · 2928 adult patients who were admitted to the ICU within 12 hours and receiving oxygen of at least 10 L/min in an open system or FiO2 of at least 50% in a closed system.

  • Randomized 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.

  • Secondary outcomes included percentage of days alive without live support at 90 days, or alive after hospital discharge, or new episodes of shock, myocardial ischemia, intestinal ischemia, or ischemic stroke.


What did they find?

  • 90-day mortality was not significantly different between the lower oxygen group and the high oxygen group (42.9% vs 42.4%; P=0.64).

  • No significant differences in all the secondary outcomes.


What are the limitations of the study?

  • No stratification based on etiology of respiratory failure.

  • Estimating FiO2 in an open system may not be accurate as it depends on the patient’s efforts.


What does it mean?

  • Lower oxygen target does not result in lower 90-day mortality in patients with acute respiratory failure.

  • No change in practice, target PaO2 60-90 mmHg.

HOT-ICU Trial