This work is part of a larger scheme in which commonly used critical care interventions, that are only poorly supported by high-quality trial data, are being systematically investigated in pragmatic trials. This has work so far included trials of fluid management, transfusion, stress ulcer prophylaxis and delirium prevention in the critically ill. With respect to mechanical ventilation in patients with acute respiratory failure, guideline work organised by the Scandinavian Society of Anaesthesia and Intensive Care has delineated several knowledge gaps. These include the selection of oxygenation targets (this trial) and choice of ventilator modes, e.g. fully controlled vs. spontaneous (triggered by the patient) ventilation. This topic was recently highlighted as a research priority and we are committed to a project in four steps: A scoping review of the literature, a description of a Nordic subset of data from the LUNG SAFE study, a randomised trial of spontaneous vs controlled breathing, and we will complete this with an update of Nordic guidelines on mechanical ventilation of patients with ARDS.
To our knowledge, the HOT-COVID trial will be the first to investigate the impact of oxygenation targets in a population of critically ill patients sharing the same aetiology, viral pneumonia caused by the SARS-CoV2-virus and clinical presentation, acute hypoxaemic respiratory failure. This may potentially uncover effects of low vs high oxygenation targets that are missed in trials comparing such targets in patients with heterogenous aetiology and a more variable presentation.