Early Hyperoxemia and Outcome Among Critically Ill Children

Area of Science:

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

Background:

• Hyperoxemia, defined as elevated partial pressure of oxygen (PaO2), is common in critically ill children.
• The association between hyperoxemia and mortality in the Pediatric Intensive Care Unit (PICU) remains unclear.
• Understanding this relationship is crucial for optimizing oxygen therapy and improving patient outcomes.

Purpose of the Study:

• To investigate the association between hyperoxemia at PICU presentation and in-hospital mortality.
• To determine if different thresholds of hyperoxemia have varying impacts on mortality.
• To evaluate the role of oxygenation status in predicting outcomes for critically ill children.

Main Methods:

• A single-center observational study analyzed data from 23,719 encounters admitted to a quaternary-care PICU between 2009 and 2018.
• A modified Pediatric Risk of Mortality IV score, excluding PaO2, was used to adjust for illness severity.
• Logistic regression models assessed the association between hyperoxemia (PaO2 ≥ 300 torr [39.99 kPa]) and in-hospital mortality, with analyses repeated for higher hyperoxemia cutoffs (≥ 550 torr [73.32 kPa]).

Main Results:

• Of 4,093 encounters with recorded PaO2, 6.7% experienced in-hospital mortality.
• Conventional hyperoxemia (≥ 300 torr) was not significantly associated with mortality in multivariable models (aOR, 1.38; 95% CI, 0.98-1.93).
• Extreme hyperoxemia (≥ 550 torr) was significantly associated with increased in-hospital mortality (aOR, 2.78; 95% CI, 2.54-3.05).

Conclusions:

• A conventional threshold for hyperoxemia in the PICU is not associated with in-hospital mortality when adjusted for illness severity.
• Extreme hyperoxemia levels (≥ 73.32 kPa) are significantly linked to increased in-hospital mortality.
• Further prospective research is needed to clarify the contribution of hyperoxemia to adverse outcomes in critically ill children.