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Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units
Sainath Raman1, Samiran Ray1, Mark J Peters1
1Respiratory, Critical Care and Anaesthesia Group, Infection, Immunity, Inflammation and Physiological Medicine Programme, Institute of Child Health, University College London and Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
Insights
Paediatric intensive care clinicians in the UK rarely use specific arterial oxygen targets. Oxygenation strategies vary by diagnosis, with lower targets used in sepsis and higher targets in traumatic brain injury.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Clinical practice research
Background:
- Supplemental oxygen is frequently administered to critically ill children.
- Current practices for oxygen administration in UK pediatric intensive care units (PICUs) are not well-defined.
Purpose of the Study:
- To investigate current UK PICU practices regarding oxygen administration.
- To explore clinicians' oxygenation targets for common diagnoses in critically ill children using a case vignette.
Main Methods:
- An online survey was distributed to members of the Paediatric Intensive Care Society in the UK.
- The survey included a clinical scenario and questions about oxygenation targets for five specific pediatric diagnoses.
Main Results:
- Fifty-three clinicians from 10 institutions participated.
- 42% of respondents did not adhere to arterial partial pressure of oxygen (PaO2) targets for moderate ventilatory requirements.
- Clinicians showed a trend towards lower PaO2 targets with increasing fraction of inspired oxygen (FiO2) in acute respiratory distress syndrome, cardiac arrest, and sepsis.
- Conversely, normal PaO2 targets were maintained regardless of FiO2 in traumatic brain injury and pulmonary hypertension.
Conclusions:
- Arterial partial pressure of oxygen targets are not consistently utilized by surveyed clinicians.
- Oxygenation strategies are tailored to specific conditions, with distinct approaches for sepsis/cardiac arrest versus traumatic brain injury/pulmonary hypertension.
Abstract:
Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU) in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42%) did not follow arterial partial pressure of oxygen (PaO2) targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2 as the fraction of inspired oxygen (FiO2) increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2 even as the FiO2 increased. Conclusions. In this sample of clinicians PaO2 targets were not commonly used. Clinicians target lower PaO2 as FiO2 increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2 in traumatic brain injury and pulmonary hypertension.
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