The New England Journal of MedicineLong-Term Oxygen Therapy for 24 or 15 Hours per Day in Severe Hypoxemia

Read the original article

A recent multicenter, registry-based, randomized controlled trial challenges the conventional wisdom on long-term oxygen therapy (LTOT) for patients with severe hypoxemia. The study compared the outcomes of LTOT used for 24 hours per day versus 15 hours per day in patients with chronic, severe hypoxemia at rest.

Key Points:

• The trial included 241 patients randomly assigned to receive LTOT for either 24 hours (117 patients) or 15 hours (124 patients) per day.
• The primary outcome was a composite of hospitalization or death from any cause within 1 year.
• Results showed no significant difference in the risk of hospitalization or death between the two groups (hazard ratio: 0.99; 95% CI: 0.72 to 1.36).
• Patient-reported adherence to the assigned duration was high in both groups.
• No substantial differences were observed in secondary outcomes, including individual components of the primary outcome and patient-reported measures.
• Subgroup analyses, including patients with COPD and those with very low baseline PaO2 (<55 mm Hg), showed similar results.
• The findings suggest that LTOT for 15 hours per day may be as effective as 24-hour therapy, potentially reducing treatment burden for patients.

HCN Medical Memo
This landmark study challenges the long-standing recommendation for 24-hour LTOT in severe hypoxemia. The findings suggest that a 15-hour regimen may be equally effective, potentially improving patient quality of life without compromising clinical outcomes. Physicians should consider these results when prescribing LTOT, balancing treatment efficacy with patient comfort and adherence.

More on Hypoxemia