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  1. Piers Dixey
  1. Respiratory Department, Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK
  1. Correspondence to Dr Piers Dixey, Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK; piers.dixey{at}nhs.net

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Despite clear evidence of safety of titrated oxygen therapy in critical illness, patients are frequently treated in the initial presentation with high inspired oxygen fractions (FiO2). The Hyper2S trial, design to assess the role of hyperoxia (FiO2 1.0 vs titrated FiO2 for SpO2 88–95% in first 24 hours) and hypertonic saline in the management of septic shock was stopped early due to high mortality in the hyperoxia group. Demiselle et al (Ann Int Care 2018;8:90) report a post hoc analysis of patients from the Hyper2S trial selected by the sepsis-3 criteria (septic shock requiring vasopressor support despite adequate fluid resuscitation with a lactaemia; >2 mmol/L). Three hundred and ninety-seven out of 442 patients had available lactate levels with 230 of those patients meeting the sepsis-3 definition (122 normoxia, 108 hyperoxia). As expected, patients with lactaemia were more unwell (higher Sequential OrganFailure Assessment core and Simplified Acute Physiology Score II, with more need for organ support) than those without lactaemia. There was a numerically higher mortality at 28 days in hyperoxia compared with normoxia patients (57% vs 44%), with hyperoxia demonstrating a significant impact on mortality in the multivariate analysis at both 28 (HR 1.79, 95% CI 1.21 to 2.63, p<0.003) and 90 (HR 1.57, 95% CI 1.09 to 2.28, p=0.016) days. The results …

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