Abstract
Oxygen supplementation is a cornerstone treatment in pediatric critical care. Accumulating evidence suggests that overzealous use of oxygen, leading to hyperoxia, is associated with worse outcomes compared with patients with normoxia. To evaluate the association of arterial hyperoxia with clinical outcome in critically ill children among studies using varied definitions of hyperoxia. A systematic search of EMBASE, MEDLINE, Cochrane Library, and ClinicalTrials.gov from inception to February 1, 2021, was conducted. Clinical trials or observational studies of children admitted to the pediatric intensive care unit that examined hyperoxia, by any definition, and described at least 1 outcome of interest. No language restrictions were applied. The Meta-analysis of Observational Studies in Epidemiology guideline and Newcastle-Ottawa Scale for study quality assessment were used. The review process was performed independently by 2 reviewers. Data were pooled with a random-effects model. The primary outcome was 28-day mortality; this time was converted to mortality at the longest follow-up owing to insufficient studies reporting the initial primary outcome. Secondary outcomes included length of stay, ventilator-related outcomes, extracorporeal organ support, and functional performance. In this systematic review, 16 studies (27 555 patients) were included. All, except 1 randomized clinical pilot trial, were observational cohort studies. Study populations included were post-cardiac arrest (n = 6), traumatic brain injury (n = 1), extracorporeal membrane oxygenation (n = 2), and general critical care (n = 7). Definitions and assessment of hyperoxia differed among included studies. Partial pressure of arterial oxygen was most frequently used to define hyperoxia and mainly by categorical cutoff. In total, 11 studies (23 204 patients) were pooled for meta-analysis. Hyperoxia, by any definition, showed an odds ratio of 1.59 (95% CI, 1.00-2.51; after Hartung-Knapp adjustment, 95% CI, 1.05-2.38) for mortality with substantial between-study heterogeneity (I2 = 92%). This association was also found in less heterogeneous subsets. A signal of harm was observed at higher thresholds of arterial oxygen levels when grouped by definition of hyperoxia. Secondary outcomes were inadequate for meta-analysis. These results suggest that, despite methodologic limitations of the studies, hyperoxia is associated with mortality in critically ill children. This finding identifies the further need for prospective observational studies and importance to address the clinical implications of hyperoxia in critically ill children.
Highlights
The administration of supplemental oxygen is a cornerstone treatment in critically ill patients to prevent and resolve cellular hypoxia
Secondary outcomes were inadequate for meta-analysis. These results suggest that, despite methodologic limitations of the studies, hyperoxia is associated with mortality in critically ill children
Oxygen therapy can be lifesaving on many occasions, its overzealous use may lead to supraphysiological levels of the arterial partial pressure of oxygen (PaO2), which is associated with deleterious outcomes
Summary
The administration of supplemental oxygen is a cornerstone treatment in critically ill patients to prevent and resolve cellular hypoxia. Oxygen therapy can be lifesaving on many occasions, its overzealous use may lead to supraphysiological levels of the PaO2 (ie, hyperoxia), which is associated with deleterious outcomes. In critically ill adults, arterial hyperoxia has been associated with increased mortality, most pronounced at extreme levels of PaO2.1,2 Detrimental effects of hyperoxia may derive from increased formation of reactive oxygen species, which damage biomolecules, or from its pulmonary and vascular complications, such as atelectasis and hyperoxemic vasoconstriction.[3,4,5,6,7]. The current practice of oxygen therapy and target oxygenation levels in the PICU are largely based on expert opinion.[14,15,16] Rigorous synthesis of the literature on the association between hyperoxia and clinical outcomes in the PICU is necessary to aid in the development of novel study protocols and future strategies to prevent oxygen-associated injury
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
