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Oxygen saturation targets for children with respiratory distress: a systematic review
Sam Louman1, Karlijn J van Stralen1, Mariëlle W H Pijnenburg2
1Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands.
Insights
Lower peripheral oxygen saturation (SpO2) thresholds may be safe for children with respiratory distress, potentially reducing hospital admissions and length of stay. Further high-quality research is needed to confirm these findings.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Evidence-based medicine
Background:
- Current peripheral oxygen saturation (SpO2) thresholds for supplemental oxygen in children with respiratory distress range from 90-94%.
- These established SpO2 thresholds are based on limited empirical evidence.
- The safety and efficacy of varying SpO2 thresholds in pediatric respiratory distress require further investigation.
Purpose of the Study:
- To systematically review existing evidence on peripheral oxygen saturation (SpO2) thresholds in pediatric respiratory distress.
- To evaluate the impact of different SpO2 thresholds on patient safety and treatment effectiveness.
- To inform clinical guidelines regarding optimal SpO2 targets in children with respiratory distress.
Main Methods:
- Systematic review of original articles published between January 2010 and January 2022.
- Inclusion criteria: studies comparing two or more SpO2 thresholds in pediatric respiratory distress.
- Outcomes assessed: mortality, neurocognitive outcomes, readmissions, admission rates, and length of hospital stay; risk of bias assessed using RoB-2 or ROBINS-I.
Main Results:
- Seven studies were included, comparing lower SpO2 thresholds (80-92%) with higher thresholds (92-94%).
- Lower SpO2 thresholds demonstrated equivalent safety outcomes (mortality, neurocognition, readmissions) compared to higher thresholds.
- Lower SpO2 thresholds significantly reduced admission rates by up to 40% and decreased hospitalisation duration by 10-18 hours.
Conclusions:
- Current SpO2 thresholds (90-94%) for pediatric respiratory distress may be unnecessarily high, potentially leading to increased hospitalizations.
- SpO2 thresholds as low as 88% appear safe and may reduce hospital admission rates and duration of stay.
- High-quality evidence is necessary to validate the use of lower SpO2 thresholds in clinical practice for children with respiratory distress.
Background:
In children with respiratory distress, supplemental oxygen is indicated at peripheral oxygen saturation (SpO) thresholds of 90-94%. However, these thresholds are poorly studied. We conducted a systematic review to summarise the existing evidence for SpO thresholds in children with respiratory distress.
Methods:
Electronic databases and registries were searched for original articles published from 1 January 2010 to 7 January 2022 comparing two or more SpO thresholds in children with respiratory distress. Primary outcomes were safety, including mortality, neurocognitive outcomes and readmissions, and effectiveness, including admission rate and length of hospital stay. Methodological appraisal was performed using the Cochrane Risk of Bias 2 (RoB-2) or Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tools. Results were narratively synthesised.
Results:
We retrieved 3384 results; seven studies were included. Lower thresholds ranged from 80% to 92% and were compared with higher thresholds ranging from 92% to 94%. Studies were highly heterogeneous in setting, design, population and outcomes. Risk of bias varied from low to high. Lower SpO thresholds had equivalent mortality, neurocognitive outcomes and readmissions or re-attendance to healthcare to higher thresholds. Lower SpO thresholds showed a significant decrease in admission rates by up to 40% and shortened hospitalisation duration by 10-18 h.
Conclusions:
The current SpO thresholds of 90-94% in children with respiratory distress may be too high, which could lead to unnecessary hospitalisations and prolonged hospitalisation duration. SpO thresholds as low as 88% are potentially safe in children with respiratory distress and may reduce hospitalisation rates and length of stay. However, high-quality evidence is needed to support this.
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