CHEST Guidelines-Lower-or-Higher-Oxygenation-Targets-in-Patients-Wi

Lower-or-Higher-Oxygenation-Targets-in-Patients-Wi

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The study analyzed the Handling Oxygenation Targets in COVID-19 (HOT-COVID) trial, which investigated the most effective oxygenation levels for ICU patients with COVID-19 and hypoxemia. The trial compared two PaO2 targets—60 mm Hg and 90 mm Hg. Although the trial stopped early due to slow recruitment, it involved 726 participants out of the planned 780. Researchers used Bayesian analysis to assess the impact of these targets on patients' outcomes, specifically examining days alive without life support and 90-day all-cause mortality.<br /><br />Key findings suggested that a lower PaO2 target of 60 mm Hg is beneficial. Patients targeting this lower level had an average increase of 5.7 days alive without life support, with a 95.2% probability of clinically relevant benefit. The study noted a 76.5% probability of reducing 90-day mortality by 4.6 percentage points with the lower oxygen target. Bayesian analysis showed an 89.8% probability of any mortality benefit from the lower oxygen target.<br /><br />The trial explored heterogeneity of treatment effects, noting that baseline norepinephrine doses and lactate concentrations might influence outcomes, suggesting patients with higher levels might benefit more from lower oxygen targets. However, these findings require cautious interpretation due to the small sample size in certain subgroups and wide credible intervals.<br /><br />In conclusion, the trial indicates a high probability that targeting a PaO2 of 60 mm Hg as opposed to 90 mm Hg can increase the days alive without life support in COVID-19 ICU patients, with some potential for reducing mortality, although these results should be interpreted cautiously and validated in future trials.

Keywords

HOT-COVID trial

oxygenation levels

ICU patients

COVID-19

hypoxemia

PaO2 targets

Bayesian analysis

mortality reduction

life support

treatment effects