Conservative oxygenation improves outcomes in critically ill children on invasive ventilation

1. Duration of organ support or death at 30 days was lower in the conservative oxygenation group compared to the liberal oxygenation group.

2. Prespecified adverse events were also lower in the conservative oxygenation group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The optimal systemic oxygenation target for critically ill children remains uncertain, with liberal oxygenation – the standard of care – posing harm. There is no underlying consensus on the optimal oxygenation target for critically ill children. This randomized controlled trial aimed to assess whether conservative oxygenation could decrease organ support duration or death compared to liberal oxygenation. The primary outcome was the duration of organ support at 30 days from randomization, while a key secondary outcome was the incidence of death. According to study results, a significant reduction in organ support duration or death was noted with conservative oxygenation when compared to a liberal oxygenation strategy. Although this study was well done, it was limited by its focus on UK PICUs, potentially limiting its generalizability.

Click to read the study in The Lancet

Relevant Reading: Oxygen-Saturation Targets for Critically Ill Adults Receiving Mechanical Ventilation

In-depth [randomized-controlled trial]: Between Sept 1, 2020, and May 15, 2022, 6089 patients were screened for eligibility across 15 pediatric intensive care units (PICUs) in the UK. Included were patients ≤ 16 years of age, admitted as emergencies, receiving invasive ventilation and supplemental oxygen. Altogether, 1872 patients (939 in the conservative oxygenation group [SpO2 88-92%] and 933 in the liberal oxygenation group [SpO2 >94%]) were included in the final analysis. The primary outcome of organ support duration at 30 days or death was significantly lower in the conservative oxygenation group versus the liberal oxygenation group (adjusted odds ratio 0.84, 95% confidence interval [CI] 0.72-0.99, p=0.04). Similarly, the secondary outcome of prespecified adverse events was lower in the conservative oxygenation group compared to the liberal oxygenation group (3% vs. 4%). Findings from this study suggest that adopting conservative oxygenation targets could improve outcomes for critically ill children in PICUs.

Image: PD

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