HOT-COVID
Trial question
Is lower oxygenation target superior to higher oxygenation target in ICU patients with COVID-19 infection with severe hypoxemia?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
29.0% female
71.0% male
N = 697
697 patients (202 female, 495 male).
Inclusion criteria: patients with COVID-19 and severe hypoxemia in the ICU.
Key exclusion criteria: > 12 hours of ICU admission; no informed consent; previous randomization in HOT-ICU or HOT-COVID trials.
Interventions
N=351 lower oxygenation target (supplemental oxygen targeting a PaO2 of 60 mmHg).
N=346 higher oxygenation target (supplemental oxygen targeting a PaO2 of 90 mmHg).
Primary outcome
Days alive without life support at day 90
80 days
72 days
80.0 days
60.0 days
40.0 days
20.0 days
0.0 days
Lower oxygenation
target
Higher oxygenation
target
Significant
increase ▲
Significant increase in days alive without life support at day 90 (80 days vs. 72 days; AD 5.8 days, 95% CI 0.2 to 11.5).
Secondary outcomes
No significant difference in the rate of death by day 90 (30.2% vs. 34.7%; RR 0.86, 95% CI 0.66 to 1.13).
No significant difference in days alive and out of hospital over day 90 (59 days vs. 48 days; AD 5.1 days, 95% CI -1.2 to 11.4).
No significant difference in serious adverse events (47.5% vs. 51.7%; RR 0.94, 95% CI 0.79 to 1.13).
Conclusion
In patients with COVID-19 and severe hypoxemia in the ICU, lower oxygenation target was superior to higher oxygenation target with respect to days alive without life support at day 90.
Reference
Frederik M Nielsen, Thomas L Klitgaard, Martin Siegemund et al. Lower vs Higher Oxygenation Target and Days Alive Without Life Support in COVID-19: The HOT-COVID Randomized Clinical Trial. JAMA. 2024 Apr 9;331(14):1185-1194.
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