Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure

Olav L Schjørring, Thomas L Klitgaard, Anders Perner, Jørn Wetterslev, Theis Lange, Martin Siegemund, Minna Bäcklund, Frederik Keus, Jon H Laake, Matthew Morgan, Katrin M Thormar, Søren A Rosborg, Jannie Bisgaard, Annette E S Erntgaard, Anne-Sofie H Lynnerup, Rasmus L Pedersen, Elena Crescioli, Theis C Gielstrup, Meike T Behzadi, Lone M PoulsenStine Estrup, Jens P Laigaard, Cheme Andersen, Camilla B Mortensen, Björn A Brand, Jonathan White, Inge-Lise Jarnvig, Morten H Møller, Lars Quist, Morten H Bestle, Martin Schønemann-Lund, Maj K Kamper, Mathias Hindborg, Alexa Hollinger, Caroline E Gebhard, Núria Zellweger, Christian S Meyhoff, Mathias Hjort, Laura K Bech, Thorbjørn Grøfte, Helle Bundgaard, Lars H M Østergaard, Maria A Thyø, Thomas Hildebrandt, Bülent Uslu, Christoffer G Sølling, Nette Møller-Nielsen, Ulf Gøttrup Pedersen, Anne S Andreasen, Janus Engstrøm, Maj-Brit N Kjær, HOT-ICU Investigators, Diana Bertelsen Jensen (Member of study group), Kasper Mørk Sørensen (Member of study group), Patrick Sprogøe Rasmussen (Member of study group), Andreas Rovsing Hjortdal (Member of study group), Nanna Reiter (Member of study group), Niels Erikstrup Clausen (Member of study group), Lars Hein (Member of study group), Michael Ibsen (Member of study group), Sigurður Þór Sigurðsson (Member of study group)

178 Citations (Scopus)


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 2) would result in lower mortality than using a higher target. 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 2 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. 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.

Original languageEnglish
JournalThe New England journal of medicine
Issue number14
Pages (from-to)1301-1311
Number of pages11
Publication statusPublished - 8 Apr 2021


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