Conservative versus liberal oxygenation targets in critically ill children: the Oxy-PICU RCT

Area of Science:

• Pediatric Intensive Care
• Critical Care Medicine
• Respiratory Physiology

Background:

• The optimal oxygen saturation target for critically ill children remains uncertain.
• Liberal oxygenation strategies may be associated with harm in observational studies.

Purpose of the Study:

• To compare the clinical and cost-effectiveness of conservative (SpO2 88-92%) versus liberal (SpO2 >94%) oxygenation targets.
• To evaluate outcomes in children admitted to the pediatric intensive care unit (PICU).

Main Methods:

• A pragmatic, open, multicenter, randomized clinical trial involving 1872 children requiring mechanical ventilation.
• Interventions involved adjusting ventilator settings to achieve either conservative or liberal oxygenation targets.
• Primary outcomes included duration of organ support or death at 30 days and cost-effectiveness at 12 months.

Main Results:

• Conservative oxygenation significantly reduced the duration of organ support or death within 30 days (p=0.04).
• Secondary outcomes and components of the primary outcome favored conservative oxygenation.
• Short-term costs were lower with conservative oxygenation, but longer-term cost-effectiveness showed wide uncertainty.

Conclusions:

• A conservative oxygenation target (SpO2 88-92%) demonstrated a higher probability of improved outcomes in critically ill children.
• Longer-term survival and quality of life were consistent with the primary findings.
• Conservative oxygenation likely reduces short-term costs, with uncertain long-term cost-effectiveness.