Hospitalization/death risk similar with daily 24-hour, 15-hour oxygen therapy in hypoxemia

Key takeaways:

• Patients can receive oxygen therapy for 15 hours a day rather than 24 hours a day with no change to their risk for hospitalization/death.
• Adjustment for age and sex did not change this outcome.

The risk for any-cause hospitalization/death at 1 year was comparable between patients with severe hypoxemia receiving daily 24-hour vs. 15-hour oxygen therapy, according to findings published in New England Journal of Medicine.

These results were also presented at the European Respiratory Society International Congress.

“Before this trial, results from randomized, controlled trials of long-term oxygen therapy in patients with severe hypoxemia had been lacking since the publication of two trials that were conducted in the 1970s,” Magnus Ekström, MD, PhD, associate professor, senior lecturer and supervisor in the department of respiratory medicine, allergology and palliative medicine at Lund University, and colleagues wrote.

“In comparison with these trials, which together included 290 patients, the current trial almost doubles the number of enrolled patients with severe hypoxemia and is more representative of present-day patients starting long-term oxygen therapy, who are older, more often female, more likely to have coexisting medical conditions, and more likely to die,” they continued.

In the multicenter, registry-based, randomized, controlled REDOX trial, Ekström and colleagues evaluated 241 patients (mean age, 76 years; 59% women; 71% with COPD; 14% with pulmonary fibrosis) with severe hypoxemia beginning to receive long-term oxygen therapy to determine how 1-year any-cause hospitalization/mortality risk differs between two lengths of oxygen therapy: 24 hours per day vs. 15 hours per day.

Of the total cohort, 117 patients (mean age, 76.4 years; 63.2% women) received oxygen therapy for 24 hours each day, and 124 patients (mean age, 75 years; 54% women) received oxygen therapy for 15 hours each day.

The median patient-reported daily duration of oxygen therapy at 12 months matched the assigned length in each group.

Researchers found a comparable mean rate of hospitalization or death within 1 year among those receiving daily 24-hour oxygen therapy and those receiving daily 15-hour oxygen therapy (124.7 events vs. 124.5 events per 100 person-years; HR = 0.99; 95% CI, 0.72-1.36).

Notably, adjustment for age and sex did not change this outcome (HR = 0.98; 95% CI, 0.71-1.36). The model adjusted for age, sex and clustering at the trial-center level also demonstrated a similar outcome (HR = 0.99; 95% CI, 0.72-1.36).

During the evaluation of any-cause hospitalization and mortality separately, researchers continued to find similar rates at 12 months between the daily 24-hour and 15-hour oxygen therapy groups.

Lastly, both sets of patients had nine registered burn injuries, fall-related injuries or nosebleeds, according to researchers.

“The findings support that there is no clear disadvantage of supplemental oxygen use for 15 hours per day rather than 24 hours per day in terms of reducing the risk of hospitalization or death within 1 year,” Ekström and colleagues wrote. “Therapy-free intervals up to 9 hours per day may substantially reduce the limitations and burdens of long-term oxygen therapy for many patients.”