Bodil Steen Rasmussen

Background The Handling Oxygenation Targets in the Intensive Care Unit (HOT‐ICU) trial was a multicentre, randomised, parallel‐group trial of a lower oxygenation target (arterial partial pressure of oxygen [PaO 2 ] = 8 kPa) versus a higher oxygenation target (PaO 2 = 12 kPa) in adult ICU patients with acute hypoxaemic respiratory failure; the Handling Oxygenation Targets in coronavirus disease 2019 (HOT‐COVID) tested the same oxygenation targets in patients with confirmed COVID‐19. In this study, we aim to evaluate the long‐term effects of these oxygenation targets on cognitive and pulmonary function. We hypothesise that a lower oxygenation target throughout the ICU stay may result in cognitive impairment, whereas a higher oxygenation target may result in impaired pulmonary function. Methods This is the updated protocol and statistical analysis plan of two pre‐planned secondary outcomes, the long‐term cognitive function, and long‐term pulmonary function, in the HOT‐ICU and HOT‐COVID trials. Patients enrolled in both trials at selected Danish sites and surviving to 1 year after randomisation are eligible to participate. A Repeatable Battery for the Assessment of Neuropsychological Status score and a full‐body plethysmography, including diffusion capacity for carbon monoxide, will be obtained. The last patient is expected to be included in the spring of 2024. Conclusion This study will provide important information on the long‐term effects of a lower versus a higher oxygenation target on long‐term cognitive and pulmonary functions in adult ICU patients with acute hypoxaemic respiratory failure.

Background Pleural effusion is common among patients in the intensive care unit (ICU) but reported prevalence varies. Thoracentesis may improve respiratory status, however, indications for this are unclear. We aimed to explore prevalence, development, and progression of pleural effusion, and the incidence and effects of thoracentesis in adult ICU patients. Methods This is a prospective observational study utilizing repeated daily ultrasonographic assessments of pleurae bilaterally, conducted in all adult patients admitted to the four ICUs of a Danish university hospital throughout a 14‐day period. The primary outcome was the proportion of patients with ultrasonographically significant pleural effusion (separation between parietal and visceral pleurae >20 mm) in either pleural cavity on any ICU day. Secondary outcomes included the proportion of patients with ultrasonographically significant pleural effusion receiving thoracentesis in ICU, and the progression of pleural effusion without drainage, among others. The protocol was published before study initiation. Results In total, 81 patients were included of which 25 (31%) had or developed ultrasonographically significant pleural effusion. Thoracentesis was performed in 10 of these 25 patients (40%). Patients with ultrasonographically significant pleural effusion, which was not drained, had an overall decrease in estimated pleural effusion volume on subsequent days. Conclusion Pleural effusion was common in the ICU, but less than half of all patients with ultrasonographically significant pleural effusion underwent thoracentesis. Progression of pleural effusion without thoracentesis showed reduced volumes on subsequent days.