丹麦奥尔堡大学医院Bodil S. Rasmussen团队比较了较低的氧合目标与较高目标对急性低氧性呼吸衰竭患者预后的影响。2021年1月20日，该研究发表在《新英格兰医学杂志》上。
在这项多中心试验中，研究组随机分配了2928名最近入住ICU的成人患者（随机分组前≤12小时），这些患者在开放系统中每分钟接受至少10升氧气，或在封闭系统中吸入的氧气分数至少为0.50，分别接受PaO2目标为60 mm Hg（低氧合组）或90 mm Hg（高氧合组）的氧气治疗，最长90天。主要结局是90天内的死亡率。
Title: Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure | NEJM
Author: Olav L. Schjrring, M.D., Ph.D.,, Thomas L. Klitgaard, M.D.,, Anders Perner, M.D., Ph.D.,, Jrn Wetterslev, M.D., Ph.D.,, Theis Lange, Ph.D.,, Martin Siegemund, M.D.,, Minna Bcklund, M.D., Ph.D.,, Frederik Keus, M.D.,, Jon H. Laake, M.D., Ph.D.,, Matthew Morgan, M.D., Ph.D.,, Katrin M. Thormar, M.D., Ph.D.,, Sren A. Rosborg, M.D., Ph.D.,, Jannie Bisgaard, M.D., Ph.D.,, Annette E.S. Erntgaard, M.D.,, Anne-Sofie H. Lynnerup, M.D.,, Rasmus L. Pedersen, M.D.,, Elena Crescioli, M.D.,, Theis C. Gielstrup, M.D.,, Meike T. Behzadi, M.D.,, Lone M. Poulsen, M.D.,, Stine Estrup, M.D., Ph.D.,, Jens P. Laigaard, M.S.,, Cheme Andersen, M.D.,, Camilla B. Mortensen, R.N.,, Bjrn A. Brand, M.D.,, Jonathan White, M.D., Ph.D.,, Inge-Lise Jarnvig, M.D., Ph.D.,, Morten H. Mller, M.D., Ph.D.,, Lars Quist, M.D., Ph.D.,, Morten H. Bestle, M.D., Ph.D.,, Martin Schnemann-Lund, M.D.,, Maj K. Kamper, M.D.,, Mathias Hindborg, M.D.,, Alexa Hollinger, M.D.,, Caroline E. Gebhard, M.D.,, Núria Zellweger, M.Sc.,, Christian S. Meyhoff, M.D., Ph.D.,, Mathias Hjort, M.D.,, Laura K. Bech, M.Sc.,, Thorbjrn Grfte, M.D., Ph.D.,, Helle Bundgaard, M.D., Ph.D.,, Lars H.M. stergaard, M.D.,, Maria A. Thy, M.D.,, Thomas Hildebrandt, M.D.,, Bülent Uslu, M.D.,, Christoffer G. Slling, M.D., Ph.D.,, Nette Mller-Nielsen, M.D.,, Anne C. Brchner, M.D., Ph.D.,, Morten Borup, M.D., Ph.D.,, Marjatta Okkonen, M.D., Ph.D.,, Willem Dieperink, Ph.D.,, Ulf G. Pedersen, M.D.,, Anne S. Andreasen, M.D., Ph.D.,, Lone Buus, M.D.,, Tayyba N. Aslam, M.D.,, Robert R. Winding, M.D.,, Joerg C. Schefold, M.D.,, Stine B. Thorup, M.D.,, Susanne A. Iversen, M.D.,, Janus Engstrm, B.Sc.,, Maj-Brit N. Kjr, R.N.,, and Bodil S. Rasmussen, M.D., Ph.D.
Patients with acute hypoxemic respiratory failure in the intensive care unit (ICU) are treated with supplemental oxygen, but the benefits and harms of different oxygenation targets are unclear. We hypothesized that using a lower target for partial pressure of arterial oxygen (Pao2) would result in lower mortality than using a higher target.
In this multicenter trial, we randomly assigned 2928 adult patients who had recently been admitted to the ICU (≤12 hours before randomization) and who were receiving at least 10 liters of oxygen per minute in an open system or had a fraction of inspired oxygen of at least 0.50 in a closed system to receive oxygen therapy targeting a Pao2 of either 60 mm Hg (lower-oxygenation group) or 90 mm Hg (higher-oxygenation group) for a maximum of 90 days. The primary outcome was death within 90 days.
At 90 days, 618 of 1441 patients (42.9%) in the lower-oxygenation group and 613 of 1447 patients (42.4%) in the higher-oxygenation group had died (adjusted risk ratio, 1.02; 95% confidence interval, 0.94 to 1.11; P=0.64). At 90 days, there was no significant between-group difference in the percentage of days that patients were alive without life support or in the percentage of days they were alive after hospital discharge. The percentages of patients who had new episodes of shock, myocardial ischemia, ischemic stroke, or intestinal ischemia were similar in the two groups (P=0.24).
Among adult patients with acute hypoxemic respiratory failure in the ICU, a lower oxygenation target did not result in lower mortality than a higher target at 90 days.