ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1603926
This article is part of the Research TopicBiomarker-Driven Strategies for Personalized Management of Systemic Inflammatory Response SyndromeView all 9 articles
Oxygen targets in patients with septic shock: the association between hyperoxia and mortality -a retrospective cohort study
Provisionally accepted
Louisa T Lalla
Anika L Weidner
Nils SchweingruberTim T HardelMaria SchröderStefan Kluge
Jörn Grensemann*- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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In critically ill patients with septic shock adequate oxygenation is crucial and hypoxia should be avoided. However, hyperoxia has been linked to formation of reactive oxygen species, inflammation and vasoconstriction, potentially harming critically ill intensive care patients. Therefore, the aim of this study was to examine the association between oxygen exposure and mortality, and to define optimal oxygen target ranges for this specific group of patients.This retrospective, single-center cohort study explored the influence of arterial oxygen partial pressure (PaO2) on the in-hospital mortality in intensive care unit (ICU) patients with septic shock. The timeweighted mean PaO2 for day 1 and the time periods of days 2-3, 4-7 and 8-14 were calculated and analyzed by multivariable binary logistic regression models and relative distribution analyses, adjusted for age and sepsis-related organ failure assessment (SOFA) score on day 1. Additionally, PaO2 integrals above thresholds of 80, 100, 120 and 150 mmHg were calculated for the periods from admission up to day 1, 3, 7 and 14, and multivariable adjusted binary logistic regression analyses were performed.A total of 2647 cases from 2463 patients between 01/2016 and 12/2022 were identified to meet the inclusion criteria. The time-weighted mean PaO2 values associated with the lowest mortality were 92, 81, 83 and 85 mmHg for day 1 and days 2-3, 4-7 and 8-14, respectively. The optimal oxygen target range decreased over time, from 77 to 103 mmHg on day 1, to 72 to 90 mmHg on days 2 and 3, and 74 to 92 mmHg for days 4 to 7. Additionally, PaO2 integrals above all set thresholds of 80, 100, 120 and 150 mmHg for all periods of time were found to be independently associated with an increased inhospital mortality (p < 0.05 for day 1; p < 0.001 for up to day 3/7/14).In this cohort, the oxygen target range of PaO2 associated with the lowest mortality for patients with Hyperoxia in Septic Shock 2025-07-19 page 3 septic shock was approximately 80 to 105 mmHg on the first day of treatment and decreased to approximately 75 to 90 mmHg during intensive care therapy.
Keywords: septic shock, Sepsis, Intensive Care, Critical ill, Hyperoxia, hypoxia, oxygenation, arterial oxygen partial pressure
Received: 01 Apr 2025; Accepted: 06 Aug 2025.
Copyright: © 2025 Lalla, Weidner, Schweingruber, Hardel, Schröder, Kluge and Grensemann. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jörn Grensemann, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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