Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Lower versus higher oxygenation targets in critically ill patients with severe hypoxaemia: secondary Bayesian analysis to explore heterogeneous treatment effects in the Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Preventing chronic postoperative pain and nerve injury. Comment on Br J Anaesth 2021; 127: 331-5

    Research output: Contribution to journalComment/debateResearchpeer-review

  2. High-dose steroids in high pain responders undergoing total knee arthroplasty: a randomised double-blind trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Six Sigma in surgery: how to create a safer culture in the operating theatre using innovative technology

    Research output: Contribution to journalEditorialResearchpeer-review

  4. Goal-directed fluid therapy in emergency abdominal surgery: a randomised multicentre trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Management of perioperative thromboprophylaxis for surgery following COVID-19: an expert-panel survey

    Research output: Contribution to journalComment/debateResearchpeer-review

  1. Long-term outcomes of dexamethasone 12 mg versus 6 mg in patients with COVID-19 and severe hypoxaemia

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Development of a core outcome set for general intensive care unit patients - a protocol

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Early postoperative complications were common in non-ambulant paediatric patients with neuromuscular scoliosis

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Management of acute atrial fibrillation in the intensive care unit: An international survey

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

BACKGROUND: In the Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial, a lower (8 kPa) vs a higher (12 kPa) PaO2 target did not affect mortality amongst critically ill adult patients. We used Bayesian statistics to evaluate any heterogeneity in the effect of oxygenation targets on mortality between different patient groups within the HOT-ICU trial.

METHODS: We analysed 90-day all-cause mortality using adjusted Bayesian logistic regression models, and assessed heterogeneous treatment effects according to four selected baseline variables using both hierarchical models of subgroups and models with interactions on the continuous scales. Results are presented as mortality probability (%) and relative risk (RR) with 95% credibility intervals (CrI).

RESULTS: All 2888 patients in the intention-to-treat cohort of the HOT-ICU trial were included. The adjusted 90-day mortality rates were 43.0% (CrI: 38.3-47.8%) and 42.3% (CrI: 37.7-47.1%) in the lower and higher oxygenation groups, respectively (RR 1.02 [CrI: 0.93-1.11]), with 36.5% probability of an RR <1.00. Analyses of heterogeneous treatment effects suggested a dose-response relationship between baseline norepinephrine dose and increased mortality with the lower oxygenation target, with 95% probability of increased mortality associated with the lower oxygenation target as norepinephrine doses increased.

CONCLUSIONS: A lower oxygenation target was unlikely to affect overall mortality amongst critically ill adult patients with acute hypoxaemic respiratory failure. However, our results suggest an increasing mortality risk for patients with a lower oxygen target as the baseline norepinephrine dose increases. These findings warrant additional investigation.

CLINICAL TRIAL REGISTRATION: NCT03174002.

Original languageEnglish
JournalBritish Journal of Anaesthesia
Volume128
Issue number1
Pages (from-to)55-64
Number of pages10
ISSN0007-0912
DOIs
Publication statusPublished - Jan 2022

Bibliographical note

Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

ID: 71678511