Long-term mortality and health-related quality of life with lower versus higher oxygenation targets in intensive care unit patients with COVID-19 and severe hypoxaemia.

Autor: Crescioli E; Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark. e.crescioli@rn.dk.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. e.crescioli@rn.dk., Nielsen FM; Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Bunzel AM; Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark., Eriksen ASB; Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark., Siegemund M; Department of Intensive Care, Acute Medicine, Basel University Hospital, Basel, Switzerland., Poulsen LM; Department of Anaesthesiology, Zealand University Hospital, Roskilde, Denmark., Andreasen AS; Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Herlev, Copenhagen, Denmark., Bestle MH; Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hillerød, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Iversen SA; Department of Anaesthesia and Intensive Care, Slagelse Hospital, Slagelse, Denmark., Brøchner AC; Department of Anaesthesia and Intensive Care, Kolding Hospital, Kolding, Denmark., Grøfte T; Department of Anaesthesia and Intensive Care, Randers Hospital, Randers, Denmark., Hildebrandt T; Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark., Laake JH; Department of Anaesthesia and Intensive Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway., Kjær MN; Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark., Lange T; Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Perner A; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark., Klitgaard TL; Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark., Schjørring OL; Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Rasmussen BS; Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2024 Oct; Vol. 50 (10), pp. 1603-1613. Date of Electronic Publication: 2024 Sep 05.
DOI: 10.1007/s00134-024-07613-2
Abstrakt: Purpose: The aim of this study was to evaluate one-year outcomes of lower versus higher oxygenation targets in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia.
Methods: We conducted pre-planned analyses of one-year mortality and health-related quality of life (HRQoL) in the Handling Oxygenation Targets in COVID-19 trial. The trial randomised 726 ICU patients with COVID-19 and hypoxaemia to partial pressure of arterial oxygen targets of 8 kPa (60 mmHg) versus 12 kPa (90 mmHg) during ICU stay up to 90 days, including readmissions. HRQoL was assessed using EuroQol visual analogue scale (EQ-VAS) and 5-level 5-dimension questionnaire (EQ-5D-5L). Outcomes were analysed in the intention-to-treat population. Non-survivors were assigned the worst possible score (zero), and multiple imputation was applied for missing EQ-VAS values.
Results: We obtained one-year vital status for 691/726 (95.2%) of patients and HRQoL data for 642/726 (88.4%). At one year, 117/348 (33.6%) of patients in the lower-oxygenation group had died compared to 134/343 (39.1%) in the higher-oxygenation group (adjusted risk ratio: 0.85; 98.6% confidence interval (CI) 0.66-1.09; p = 0.11). Median EQ-VAS was 50 (interquartile range, 0-80) versus 40 (0-75) (adjusted mean difference: 4.8; 98.6% CI  - 2.2 to 11.9; p = 0.09) and EQ-5D-5L index values were 0.61 (0-0.81) in the lower-oxygenation group versus 0.43 (0-0.79) (p = 0.20) in the higher-oxygenation group, respectively.
Conclusion: Among adult ICU patients with COVID-19 and severe hypoxaemia, one-year mortality results were most compatible with benefit of the lower oxygenation target, which did not appear to result in more survivors with poor quality of life.
(© 2024. The Author(s).)
Databáze: MEDLINE
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