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Published on: December 5, 2025
Using a Quality Improvement Initiative to Decrease Oxygen Toxicity among Mechanically Ventilated Children.
Salim Aljabari1, Ethan Gillett1, Zach Settle2
1From the Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark.
Pediatric Quality & Safety
|May 15, 2026
Summary
Excessive oxygen in critically ill children can cause harm. This quality improvement initiative successfully reduced hyperoxia exposure in mechanically ventilated children using electronic health record alerts and standardized goals.
Area of Science:
- Pediatric Critical Care Medicine
- Quality Improvement Science
- Clinical Practice Management
Background:
- Excessive oxygen supplementation in critically ill children can lead to hyperoxia, causing systemic toxicity and adverse outcomes.
- Despite evidence of harm, overuse of oxygen therapy is common in pediatric intensive care units.
- The Second Pediatric Acute Lung Injury Consensus Conference guidelines recommend specific oxygen saturation targets.
Purpose of the Study:
- To reduce hyperoxia exposure in mechanically ventilated children within a pediatric intensive care unit.
- To implement and evaluate quality improvement interventions for optimizing oxygen therapy.
- To align clinical practice with established guidelines for oxygen management in pediatric patients.
Main Methods:
- A multidisciplinary team employed a quality improvement initiative using two Plan-Do-Study-Act cycles.
- Interventions included staff education, standardization of oxygen saturation (SpO2) goals (90%-97%) in electronic health records, and a best practice advisory.
- Data on hourly SpO2-FiO2 pairs were collected to calculate monthly hyperoxia rates (defined as SpO2 98%-100% with FiO2 > 0.21).
Main Results:
- The average hyperoxia rate decreased from a baseline of 54.8% to 41.0% after the first intervention cycle.
- Following the implementation of a best practice advisory, the hyperoxia rate further reduced to 28% and was sustained for over 12 months.
- No significant changes were observed in mortality rates (11.7% to 9.4%) or duration of mechanical ventilation (8.16 to 4.8 days).
Conclusions:
- Quality improvement methodologies and electronic health record-based decision support tools effectively reduced hyperoxia rates in mechanically ventilated children.
- Standardized oxygen management protocols are crucial for improving patient care and outcomes.
- Real-time alerts and reminders for healthcare staff can enhance adherence to best practices in oxygen therapy.
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