JAMA

What’s the optimal PaO2 target for COVID-19 patients in the ICU?

March 26, 2024

Among adult patients in the ICU with COVID-19 and severe hypoxemia, those in the lower oxygenation group (PaO2 target, 60 mm Hg) were alive for more days without life support over 90 days compared with the higher oxygenation group (PaO2 target, 90 mm Hg).

• HOT-COVID was a multicenter, randomized trial involving 726 adults with COVID-19 receiving ≥10 L/min of O2 or mechanical ventilation in 11 European ICUs between August 2020 and March 2023. The trial was stopped early, prior to outcome assessment, due to slow enrollment. Primary outcome: number of days alive without life support (mechanical ventilation, circulatory support, or kidney replacement therapy) at 90 days. Secondary outcomes: mortality, proportion of participants with serious adverse events, and number of days alive and out of hospital, all at 90 days.
• Primary outcome data were available for 697 participants (351 in the lower oxygenation group and 346 in the higher oxygenation group). Median age was 66 years, and 68% of patients were male. At 90 days, median number of days alive without life support was 80.0 days in the lower oxygenation group vs. 72.0 days in the higher oxygenation group (P = .009). Mortality rate at 90 days was 30.2% in the lower oxygenation group and 34.7% in the higher oxygenation group, a nonsignificant difference (risk ratio, 0.86; 98.6% confidence interval, 0.66-1.13; P = .18). Proportion of patients with serious adverse events and number of days alive and out of hospital were similar between groups.

Source:

Nielsen FM, et al. (2024, March 19). JAMA. Lower vs Higher Oxygenation Target and Days Alive Without Life Support in COVID-19: The HOT-COVID Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/38501214/