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HOT-ICU RCT – PaO2 Target 60 or 90mm Hg?

April 1, 2021

Written by Clay Smith

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There was no difference in 90-day mortality in critically ill patients with significant oxygen requirement between those with a PaO2 target of 60mm Hg vs 90mm Hg.

Why does this matter?
The target PaO2 is elusive in critically ill patients. Not enough oxygen is definitely bad. LOCO2 seemed to worsen outcomes with a low O2 target (PaO2 55-70mm Hg). However, too much oxygen is also bad, i.e. Oxygen-ICU; IOTA; ICU-ROX (null result); huge study in Chest; and yet another study in Am J Respir Crit Care Med. Does a conservative oxygenation target impact meaningful patient outcome

HOT-ICU – you ICU hotties!
This was a multicenter RCT with 2,928 patients receiving at least 10L (non-intubated) or 50% (intubated or closed system); half had a 60mm Hg PaO2 target and half had a 90mm Hg PaO2 target. For the primary outcome of 90-day mortality, there was no difference in the groups. There was also no difference in secondary outcomes. What I glean is that we probably can’t put too fine a point on this. Somewhere in the PaO2 60-90mm Hg range (SpO2 ~90-97%) seems to be just fine.

Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure. N Engl J Med. 2021 Jan 20. doi: 10.1056/NEJMoa2032510. Online ahead of print.

What are your thoughts?