Lower Oxygenation Goals Led to More Days Alive and Off Mechanical Ventilation in Patients with COVID-19

We do not know the “right” oxygenation target for patients with hypoxemic respiratory failure. Injury from hyperoxia can occur when partial pressure of oxygen (PaO₂) levels are too high, but delivery of oxygen to tissues can be inadequate with lower PaO₂ targets. During the COVID-19 pandemic, limited resources (e.g., mechanical ventilators) heightened the debate about oxygenation targets.

European investigators randomized 726 patients with COVID-19 and severe hypoxemia (i.e., patients receiving supplemental oxygen at 10 L/minute flow or mechanical ventilation) to a PaO₂ oxygenation target of either 60 mm Hg or 90 mm Hg. Titration of oxygen, intubation, and weaning from mechanical support were at clinicians' discretion. About one quarter of patients were intubated at enrollment; this number nearly doubled during the trial. Both PaO₂ and peripheral oxygenation saturation (SpO₂) had good separation between groups at 30 days.

At 90 days, mortality did not differ between groups, although the number of days alive without life support was higher in the lower-oxygenation target group. This difference was driven primarily by lower use of mechanical ventilation.