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Intensive Care Medicine

, Volume 43, Issue 1, pp 146–147 | Cite as

Liberal oxygenation in paediatric intensive care: retrospective analysis of high-resolution SpO2 data

  • Samiran RayEmail author
  • L. Rogers
  • S. Raman
  • M. J. Peters
  • On behalf of the Oxy-PICU investigators
Letter

Dear Editor,

Severe hypoxia is detrimental during critical illness, but hyperoxia has also been associated with adverse outcomes [1, 2, 3]. Harm from hyperoxia may be a biological consequence of oxidative damage or reflect iatrogenic injury resulting from more aggressive care. ARDSnet protocols include conservative oxygenation targets (arterial oxygen saturation (SpO2) 88–95%) [4] in recognition of the fact that the harms of high inspired oxygen fractions (FiO2) and ventilation volumes and pressures may outweigh any advantage of an additional buffer against hypoxia.

Where does this balance of harm and benefit of oxygenation lie on the paediatric intensive care unit (PICU)? As part of preliminary work towards our Oxy-PICU trial for conservative versus liberal oxygenation targets, we investigated current practice at a large general PICU over 12 months. Children were selected on the basis of a measured actual oxygen content in arterial blood (PaO2):FiO2ratio (PF) of <300 mmHg (8217...

Keywords

Paediatric Intensive Care Unit Mean Airway Pressure High FiO2 Lower SpO2 Pragmatic Clinical Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Conflicts of interest

Sainath Raman is a co-investigator and Mark Peters is the Chief Investigator on Oxy-PICU: a randomised feasibility multiple centre trial of conservative versus liberal oxygenation targets in critically ill children, funded by Great Ormond Street Hospital Children’s Charity. The other investigators are Dr. P Ramnarayan, Prof M Grocott, Dr. D Harrision, Prof Kathy Rowan, P Mouncey, Dr. S Eaton, Dr. D Inwald, Dr. J Pappachan and N and S Heinoch.

Funding

This work was undertaken at Great Ormond Street Hospital/UCL Institute of Child Health, which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centre’s funding scheme.

Ethical approval

The study was registered with the Institutional Audit Department (ref 2013). Individual patient consent was not sought as this is a retrospective observational study and no patient identifiable data is reported.

Supplementary material

134_2016_4606_MOESM1_ESM.tif (49 kb)
Supplementary material 1 (TIFF 49 kb)

References

  1. 1.
    Raman S, Prince NJ, Hoskote A, Ray S, Peters MJ (2016) Admission PaO2 and mortality in critically Ill children: a cohort study and systematic review. Pediatr Crit Care Med. 17(10):e444–e450CrossRefPubMedGoogle Scholar
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    de Jonge E, Peelen L, Keijzers PJ, Joore H, de Lange D, van der Voort PH, Bosman RJ, de Waal RA, Wesselink R, de Keizer NF (2008) Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care 12(6):R156. doi: 10.1186/cc7150 CrossRefPubMedPubMedCentralGoogle Scholar
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    Girardis M, Busani S, Damiani E, Donati A, Rinaldi L, Marudi A, Morelli A, Antonelli M, Singer M (2016) Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA 316(15):1583–1589. doi: 10.1001/jama.2016.11993 CrossRefPubMedGoogle Scholar
  4. 4.
    NIH NHLBI ARDS Clinical Network (2008) ARDSnet mechanical ventilation protocol card. http://www.ardsnet.org/tools.shtml. Accessed Sept 2016
  5. 5.
    Raman S, Ray S, Peters MJ (2016) Survey of oxygen delivery practices in UK paediatric intensive care units. Crit Care Res Pract. 2016:6312970. doi: 10.1155/2016/6312970 PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  1. 1.Respiratory Critical Care and Anaesthesia SectionUCL GOS Institute of Child HealthLondonUK
  2. 2.UCL Clinical Operational Research Unit, Department of MathematicsLondonUK

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