Klitgaard Thomas L, Schjørring Olav L, Severinsen Marianne T, Perner Anders, Rasmussen Bodil S
Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
BJA Open. 2022 Sep 23;4:100090. doi: 10.1016/j.bjao.2022.100090. eCollection 2022 Dec.
Patients admitted to an intensive care unit (ICU) with active haematological malignancy and hypoxaemic respiratory failure have a high mortality. Oxygen supplementation is essential, but limited information exists on the optimum oxygenation targets in these patients.
This subgroup analysis was specified before completion of the Handling Oxygenation Targets in the ICU (HOT-ICU) trial. The trial investigated the effects of a lower (8 kPa) a higher (12 kPa) arterial oxygenation target and was stratified for active haematological malignancy, chronic obstructive pulmonary disease, and site. We here report the primary outcome (90-day mortality) and selected secondary outcomes in the subgroup of patients with active haematological malignancy.
The HOT-ICU trial included 168 patients with active haematological malignancy; 82 were randomly allocated to an arterial oxygenation target of 8 kPa, and 86 to 12 kPa. At 90 days, 53/81 patients (65%) in the lower-oxygenation group and 47/86 patients (55%) in the higher-oxygenation group had died: adjusted relative risk 1.22 (95% confidence interval 0.95-1.56); at 1 year, the numbers were 58/81 (72%) 56/86 (65%): adjusted relative risk 1.11 (95% confidence interval 0.90-1.36). No statistically significant differences were found for any secondary outcomes.
In ICU patients with active haematological malignancies and hypoxaemic respiratory failure, we found a high mortality at 90 days and 1 year. Our results did not preclude clinically relevant benefits or harms of a lower oxygenation target in patients with active haematological malignancy. A randomised trial may, therefore, be worthwhile for these patients.
NCT03174002.
因活动性血液系统恶性肿瘤和低氧性呼吸衰竭入住重症监护病房（ICU）的患者死亡率很高。补充氧气至关重要，但关于这些患者的最佳氧合目标的信息有限。
该亚组分析在ICU中处理氧合目标（HOT-ICU）试验完成之前就已确定。该试验研究了较低（8 kPa）和较高（12 kPa）动脉氧合目标的效果，并按活动性血液系统恶性肿瘤、慢性阻塞性肺疾病和部位进行了分层。我们在此报告活动性血液系统恶性肿瘤患者亚组的主要结局（90天死亡率）和选定的次要结局。
HOT-ICU试验纳入了168例活动性血液系统恶性肿瘤患者；82例被随机分配至动脉氧合目标为8 kPa组，86例被分配至12 kPa组。90天时，低氧合组81例患者中有53例（65%）死亡，高氧合组86例患者中有47例（55%）死亡：调整后相对风险为1.22（95%置信区间0.95-1.56）；1年时，相应数字分别为58/81（72%）和56/86（65%）：调整后相对风险为1.11（95%置信区间0.90-1.36）。任何次要结局均未发现统计学上的显著差异。
在患有活动性血液系统恶性肿瘤和低氧性呼吸衰竭的ICU患者中，我们发现90天和1年时死亡率很高。我们的结果并未排除较低氧合目标对活动性血液系统恶性肿瘤患者产生的临床相关益处或危害。因此，对于这些患者，进行一项随机试验可能是值得的。
NCT03174002。
