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Conservative versus liberal oxygenation targets in critically ill children: the randomised multiple-centre pilot

Mark J Peters1,2, Gareth A L Jones3,4, Daisy Wiley5

  • 1Respiratory Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK. mark.peters@ucl.ac.uk.

Intensive Care Medicine
|June 6, 2018
PubMed

Insights

This study found that a conservative oxygen saturation target (88-92%) is feasible for critically ill children, with no significant difference in outcomes compared to a liberal target (>94%). Further trials on optimal oxygen saturation levels in pediatric intensive care are warranted.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Clinical Trial Design

Background:

  • Oxygen saturation (SpO2) monitoring is standard for children on respiratory support.
  • No randomized trials have compared SpO2 targets in critically ill children.
  • High SpO2 targets (>94%) may pose risks outweighing benefits.

Purpose of the Study:

  • To assess the feasibility of a randomized clinical trial comparing conservative versus liberal oxygenation targets in critically ill children.
  • To evaluate recruitment rates, protocol adherence, and safety of different SpO2 targets.

Main Methods:

  • An open, parallel-group randomized trial was conducted in three pediatric intensive care units.
  • Children aged 38 weeks gestation to 16 years receiving respiratory support were assigned to conservative (SpO2 88-92%) or liberal (SpO2 >94%) groups.
  • A 'research without prior consent' approach was used, with subsequent consent sought.

Main Results:

  • 119 children were randomized, achieving a recruitment rate of 10 patients/month/site.
  • The conservative group had a median SpO2 of 94.9% and the liberal group 97.5%.
  • No significant differences were observed in length of stay, organ support, or mortality; two cardiac arrests occurred in the liberal group.

Conclusions:

  • A definitive clinical trial on peripheral oxygen saturation targets in critically ill children is feasible.
  • The study demonstrated successful recruitment and adherence for comparing SpO2 targets.
  • Further research is needed to establish optimal SpO2 targets for pediatric intensive care.
Abstract

Keywords:
Clinical trialOxygenationPICU respiratory failure

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