Conservative versus liberal oxygenation targets in critically ill children: the randomised multiple-centre pilot Oxy-PICU trial
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Oxygen saturation monitoring for children receiving respiratory support is standard worldwide. No randomised clinical trials have compared peripheral oxygen saturation (SpO2) targets for critically ill children. The harm of interventions to raise SpO2 to > 94% may exceed their benefits.
We undertook an open, parallel-group randomised trial of children > 38 weeks completed gestation and < 16 years of age receiving invasive or non-invasive respiratory support and supplemental oxygen who were admitted urgently to one of three paediatric intensive care units. A ‘research without prior consent’ approach was employed. Children were randomly assigned to a liberal oxygenation group (SpO2 targets > 94%) or a conservative oxygenation group (SpO2 = 88–92% inclusive). Outcomes were measures of feasibility: recruitment rate, protocol adherence and acceptability, between-group separation of SpO2 and safety. The Oxy-PICU trial was registered before recruitment: ClinicalTrials.gov identifier NCT03040570.
A total of 159 children met the inclusion criteria, of whom 119 (75%) were randomised between April and July 2017, representing a rate of 10 patients per month per site. The mean time to randomisation from first contact with an intensive care team was 1.9 (SD 2.2) h. Consent to continue in the study was obtained in 107 cases (90%); the children’s parents/legal representatives were supportive of the consent process. The median (interquartile range, IQR) of time-weighted individual mean SpO2 was 94.9% (92.6–97.1) in the conservative oxygenation group and 97.5% (96.2–98.4) in the liberal group [difference 2.7%, 95% confidence interval (95% CI) 1.3–4.0%, p < 0.001]. Median (IQR) time-weighted individual mean FiO2 was 0.28 (0.24–0.37) in the conservative group and 0.37 (0.30–0.42) in the liberal group (difference 0.08, 95% CI 0.03–0.13, p < 0.001). There were no significant between-group differences in length of stay, duration of organ support or mortality. Two prespecified serious adverse events (cardiac arrests) occurred, both in the liberal oxygenation group.
A definitive clinical trial of peripheral oxygen saturation targets is feasible in critically ill children.
KeywordsPICU respiratory failure Oxygenation Clinical trial
The authors would like to thank the medical and nursing staff at each trial site, the Paediatric Intensive Care Society Study Group, and the patients and their families who contributed to this study. We are also grateful to members of the Trial Steering Committee and Data Monitoring Committee for their assistance in performing this study.
This study was funded by Great Ormond Street Hospital Children’s Charity. Registered Charity No. 235825 and supported by the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the UK Department of Health.
Compliance with ethical standards
Conflicts of interest
No conflicts of interest to declare.
- 4.PICANet (2017) Paediatric Intensive Care Audit Network, pp1–51. https://www.picanet.org.uk/Audit/Annual-Reporting/PICANet_2017_Annual_Report_Tables_and_Figures_FINAL_v2.0.pdf
- 20.Khoshnood A, Carlsson M, Akbarzadeh M et al (2015) The effects of oxygen therapy on myocardial salvage in ST elevation myocardial infarction treated with acute percutaneous coronary intervention: the supplemental oxygen in catheterized coronary emergency reperfusion (SOCCER) study. Cardiology 132:16–21. https://doi.org/10.1159/000398786 CrossRefPubMedGoogle Scholar
- 24.Jones GAL, Ramnarayan P, Raman S et al (2017) Protocol for a randomised pilot multiple centre trial of conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU). BMJ Open 7:e019253–e019258. https://doi.org/10.1136/bmjopen-2017-019253 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Maitland K, Kiguli S, Opoka RO et al (2017) Children’s oxygen administration strategies trial (COAST): a randomised controlled trial of high flow versus oxygen versus control in African children with severe pneumonia. Wellcome Open Res 2:100. https://doi.org/10.12688/wellcomeopenres.12747.1 CrossRefPubMedGoogle Scholar