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Inadequate Oxygen Delivery Dose and Major Adverse Events in Critically Ill Children With Sepsis
Katie L Roy1, Anna Fisk2, Peter Forbes3
1Katie L. Roy is a nurse practitioner in the medical-surgical intensive care unit (ICU), Cardiovascular and Critical Care Services, Boston Children's Hospital, and a DNP graduate, Northeastern University, Boston, Massachusetts.
Insights
Higher inadequate oxygen delivery (IDo2) doses in critically ill children with sepsis correlate with major adverse events and poor outcomes. Routine IDo2 monitoring can identify high-risk patients for timely intervention.
Area of Science:
- Pediatric Critical Care Medicine
- Hemodynamics
- Sepsis Pathophysiology
Background:
- Inadequate oxygen delivery (IDo2) index assesses systemic oxygen delivery but its role in pediatric sepsis is unclear.
- Sepsis is a leading cause of mortality in critically ill children, necessitating improved monitoring tools.
Purpose of the Study:
- To investigate the association between IDo2 dose and adverse events, illness severity, and outcomes in critically ill children with sepsis.
- To determine if IDo2 monitoring can predict adverse events in pediatric sepsis.
Main Methods:
- Retrospective analysis of clinical and IDo2 data from 102 critically ill children with sepsis.
- Statistical analysis included descriptive, nonparametric, odds ratio, and correlational methods.
Main Results:
- Elevated IDo2 doses were significantly linked to major adverse events across multiple time intervals (0-48 hours).
- Patients with IDo2 doses at or above the 80th percentile (0-12 hours) had substantially higher odds of adverse events (OR, 23.6).
- IDo2 dose correlated significantly with illness severity scores (PELOD-2), vasoactive-inotropic support, ventilation duration, ICU stay, and age.
Conclusions:
- Routine IDo2 monitoring in critically ill children with sepsis can identify those at highest risk for adverse events.
- Early identification of high-risk patients through IDo2 monitoring may facilitate timely interventions to improve outcomes.
Background:
The inadequate oxygen delivery (IDo2) index is used to estimate the probability that a patient is experiencing inadequate systemic delivery of oxygen. Its utility in the care of critically ill children with sepsis is unknown.
Objective:
To evaluate the relationship between IDo2 dose and major adverse events, illness severity metrics, and outcomes among critically ill children with sepsis.
Methods:
Clinical and IDo2 data were retrospectively collected from the records of 102 critically ill children with sepsis, weighing >2 kg, without preexisting cardiac dysfunction. Descriptive, nonparametric, odds ratio, and correlational statistics were used for data analysis.
Results:
Inadequate oxygen delivery doses were significantly higher in patients who experienced major adverse events (n = 13) than in those who did not (n = 89) during the time intervals of 0 to 12 hours (P < .001), 12 to 24 hours (P = .01), 0 to 24 hours (P < .001), 0 to 36 hours (P < .001), and 0 to 48 hours (P < .001). Patients with an IDo2 dose at 0 to 12 hours at or above the 80th percentile had the highest odds of a major adverse event (odds ratio, 23.6; 95% CI, 5.6-99.4). Significant correlations were observed between IDo2 dose at 0 to 12 hours and day 2 maximum vasoactive inotropic score (ρ = 0.27, P = .006), day 1 Pediatric Logistic Organ Dysfunction (PELOD-2) score (ρ = 0.41, P < .001), day 2 PELOD-2 score (ρ = 0.44, P < .001), intensive care unit length of stay (ρ = 0.35, P < .001), days receiving invasive ventilation (ρ = 0.42, P < .001), and age (ρ = -0.47, P < .001).
Conclusions:
Routine IDo2 monitoring may identify critically ill children with sepsis who are at the highest risk of adverse events and poor outcomes.
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