Hyperoxemia Is Associated With Mortality in Critically Ill Children.

Area of Science:

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

Background:

• Adult studies indicate a non-linear association between arterial partial pressure of oxygen (PaO2) and clinical outcomes.
• High levels of supplemental oxygen (hyperoxia) in adults are linked to increased mortality.
• The relationship between PaO2 and mortality in non-neonatal pediatric populations requires further investigation.

Purpose of the Study:

• To review the pediatric literature on the relationship between PaO2 and mortality in critically ill children.
• To synthesize findings from observational studies regarding hyperoxia and pediatric mortality.
• To inform clinical practice regarding supplemental oxygen use in pediatric intensive care.

Main Methods:

• Review of eleven observational studies published over the past decade on pediatric ICU populations.
• Analysis of studies examining the relationship between PaO2 values and mortality.
• Inclusion of analyses restricted to specific time points, number of hyperoxemic events, and risk-adjustment methods.

Main Results:

• A generally parabolic ('U-shaped') relationship between PaO2 and mortality was reported in mixed pediatric ICU populations.
• The threshold for deleterious hyperoxemia varied widely across studies (300-550 mmHg).
• This relationship remained robust across different analytical approaches and patient subgroups, including post-cardiac arrest care.

Conclusions:

• A consistent parabolic relationship exists between PaO2 and risk-adjusted pediatric ICU mortality.
• The precise threshold at which hyperoxemia becomes harmful in children remains unclear.
• Judicious use of supplemental oxygen is recommended for critically ill children, considering potential risks.