Lower or higher oxygenation targets for acute Hypoxaemic respiratory failure: Protocol for an individual patient data meta-analysis

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Background
Supplemental oxygen therapy is central to the treatment of acute hypoxaemic respiratory failure, a condition which remains a major driver for morbidity and mortality in intensive care. Despite several large randomised clinical trials comparing a higher versus a lower oxygenation target for these patients, significant differences in study design impede analysis of aggregate data and final clinical recommendations.

Methods
This paper presents the protocol for conducting an individual patient data meta-analysis where full individual patient data according to the intention-to-treat principle will be pooled from the HOT-ICU and HOT-COVID trials in a one-step procedure. The two trials are near-identical in design. We plan to use a hierarchical general linear mixed model that accounts for data clustering at a trial and site level. The primary outcome will be 90-day all-cause mortality while the secondary outcome will be days alive without life-support at 90 days. Further, we outline 14 clinically relevant predefined subgroups which we will analyse for heterogeneity in the intervention effects and interactions, and we present a plan for assessing the credibility of the subgroup analyses.

Conclusion
The presented individual patient data meta-analysis will synthesise individual level patient data from two of the largest randomised clinical trials on targeted oxygen therapy in intensive care. The results will provide a re-analysis of the intervention effects on the pooled intention-to-treat populations and facilitate subgroup analyses with an increased power to detect clinically important effect modifications.
OriginalsprogEngelsk
TidsskriftActa Anaesthesiologica Scandinavica
Vol/bind67
Udgave nummer6
Sider (fra-til)811-819
Antal sider9
ISSN0001-5172
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
the Innovation Fund Denmark, Grant/Award Number: 4108‐00011A; the Novo Nordisk Foundation; the Obel Family Foundation; Regionernes Medicinpulje; the Danish Society of Anaesthesiology and Intensive Care Medicine; the Intensive Symposium Hindsgavl; Danish Ministry of Higher Education and Research, Grant/Award Number: 0238‐00004B Funding information

Funding Information:
The HOT‐ICU trial was funded by the Innovation Fund Denmark (4108‐00011A), the Novo Nordisk Foundation, the Obel Family Foundation, Regionernes Medicinpulje, the Danish Society of Anaesthesiology and Intensive Care Medicine, and the Intensive Symposium Hindsgavl. The HOT‐COVID trial was funded by the Danish Ministry of Higher Education and Research (0238‐00004B), and the Novo Nordisk Foundation. Funding sources had no influence on trial designs, trial conduct, data collection, data analysis, result interpretation, or the scientific content of the present protocol.

Publisher Copyright:
© 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

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