• Bodil S Rasmussen, Thomas L Klitgaard, Anders Perner, Björn A Brand, Thomas Hildebrandt, Martin Siegemund, Alexa Hollinger, Søren R Aagaard, Morten H Bestle, Klaus V Marcussen, Anne C Brøchner, Christoffer G Sølling, Lone M Poulsen, Jon H Laake, Tayyba N Aslam, Minna Bäcklund, Marjatta Okkonen, Matthew Morgan, Mike Sharman, Theis Lange, Jørn Wetterslev, and Olav L Schjørring.
• Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
• Acta Anaesthesiol Scand. 2022 Jan 1; 66 (1): 76-84.

BackgroundSupplemental oxygen is the key intervention for severe and critical COVID-19 patients. With the unstable supplies of oxygen in many countries, it is important to define the lowest safe dosage.MethodsIn spring 2020, 110 COVID-19 patients were enrolled as part of the Handling Oxygenation Targets in the ICU trial (HOT-ICU). Patients were allocated within 12 h of ICU admission. Oxygen therapy was titrated to a partial pressure of arterial oxygen (PaO2 ) of 8 kPa (lower oxygenation group) or a PaO2 of 12 kPa (higher oxygenation group) during ICU stay up to 90 days. We report key outcomes at 90 days for the subgroup of COVID-19 patients.ResultsAt 90 days, 22 of 54 patients (40.7%) in the lower oxygenation group and 23 of 55 patients (41.8%) in the higher oxygenation group had died (adjusted risk ratio: 0.87; 95% confidence interval, 0.58-1.32). The percentage of days alive without life support was significantly higher in the lower oxygenation group (p = 0.03). The numbers of severe ischemic events were low with no difference between the two groups. Proning and inhaled vasodilators were used more frequently, and the positive end-expiratory pressure was higher in the higher oxygenation group. Tests for interactions with the results of the remaining HOT-ICU population were insignificant.ConclusionsTargeting a PaO2 of 8 kPa may be beneficial in ICU patients with COVID-19. These results come with uncertainty due to the low number of patients in this unplanned subgroup analysis, and insignificant tests for interaction with the main HOT-ICU trial.Trial Registration NumberClinicalTrials.gov number, NCT03174002. Date of registration: June 2, 2017.© 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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