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Admission Hyperoxia Is a Risk Factor for Mortality in Pediatric Intensive Care
Andrew Numa1,2, Himanshu Aneja1, John Awad1,2
1Intensive Care Unit, Sydney Children's Hospital, Randwick, NSW, Australia.
Insights
High oxygen levels (hyperoxia) in pediatric intensive care patients upon admission are linked to a greater risk of death. This study found a significant correlation between elevated PaO2 and increased mortality risk in critically ill children.
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.
Objectives:
To determine whether the association between hyperoxia and increased risk-adjusted mortality in adult intensive care patients is also observed in a pediatric intensive care population.
Design:
Single-center retrospective analysis of admissions to ICU over a 5-year period commencing January 1, 2012, examining the relationship between PaO2 measured within the first hour of admission and risk-adjusted mortality. Standardized mortality rates were calculated using the Pediatric Index of Mortality-3, and patients were grouped into 50 mm Hg (6.67 kPa) PaO2 bands to assess the relationship between initial PaO2 and risk-adjusted mortality.
Setting:
Tertiary PICU with 17 beds and 1,100 annual admissions located in metropolitan Sydney, Australia.
Patients:
A total of 1,447 patients 0-18 years old with PaO2 recorded at admission to the ICU.
Interventions:
None.
Measurements And Main Results:
There were 5,176 patients admitted to the ICU during the study period and 1,447 (28%) with PaO2 recorded at admission. A U-shaped relationship between raw mortality and admission PaO2 was observed, with lowest mortality (2.3% and 2.6%, respectively) observed in the 101-150 (13.5-20.0 kPa) and 151-200 mm Hg (20.1-26.7 kPa) bands and the highest mortality observed in patients with PaO2 less than 50 mm Hg (6.67 kPa) with mortality of 5.3%, or greater than 350 mm Hg (46.7 kPa) with mortality of 18.2%. Hyperoxia at admission was associated with an increase in risk-adjusted mortality, with polynomial regression indicating a strong correlation between PaO2 band and risk-adjusted outcome (r = 0.845). When included in a multivariate model that included the Pediatric Index of Mortality-3 variables, the odds ratio for hyperoxia (defined as PaO2 > 250 mm Hg [33.3 kPa]) predicting death was 2.66 (p = 0.047).
Conclusions:
In this single-center study, hyperoxia at admission to the PICU was highly correlated with increased risk-adjusted mortality. Further investigation of these observations in a large multicenter cohort is warranted.
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