Admission Hyperoxia Is a Risk Factor for Mortality in Pediatric Intensive Care

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Clinical Outcomes Research

Background:

• Hyperoxia, or excessive oxygen, is a concern in adult intensive care units (ICUs) and has been associated with increased mortality.
• The impact of hyperoxia on mortality in pediatric intensive care unit (PICU) populations is less understood.
• Understanding this association is crucial for optimizing oxygen therapy in critically ill children.

Purpose of the Study:

• To investigate whether the association between hyperoxia and increased risk-adjusted mortality observed in adult ICU patients also exists in pediatric ICU patients.
• To determine the relationship between initial partial pressure of oxygen (PaO2) levels and risk-adjusted mortality in critically ill children.

Main Methods:

• A single-center retrospective analysis of 1,447 pediatric patients admitted to the ICU between January 1, 2012, and December 31, 2016.
• PaO2 was measured within the first hour of ICU admission and categorized into 50 mm Hg bands.
• Risk-adjusted mortality was calculated using the Pediatric Index of Mortality-3 (PIM-3).

Main Results:

• A U-shaped relationship was observed between raw mortality and admission PaO2, with the lowest mortality in the 101-200 mm Hg range.
• Highest mortality occurred in patients with PaO2 < 50 mm Hg (5.3%) and > 350 mm Hg (18.2%).
• Hyperoxia (PaO2 > 250 mm Hg) was significantly associated with increased risk-adjusted mortality (Odds Ratio = 2.66, p = 0.047).

Conclusions:

• Hyperoxia at the time of PICU admission is strongly correlated with increased risk-adjusted mortality in pediatric patients.
• These findings suggest that careful management of oxygen levels is important in critically ill children.
• Further multicenter studies are needed to validate these observations in a larger cohort.