Science, Medicine, and the Anesthesiologist

Various clinical trials have been performed to identify the optimal oxygenation for invasively ventilated children, but it remains unclear whether targeting lower oxygen saturation might be superior to a liberal oxygenation strategy. A multicenter, open, parallel-group randomized clinical trial at 15 United Kingdom pediatric intensive care units (ICUs) was performed including children aged 38 weeks up to 16 yr admitted to pediatric ICUs emergently to receiving invasive ventilation and supplemental oxygen. The aim of the study was to evaluate whether a conservative oxygenation target of Spo₂ 88% to 92% would decrease duration of organ support at 30 days following randomization in comparison to a liberal oxygenation target of Spo₂ more than 94%. This primary endpoint was defined as a rank-based organ support received between days 1 and 30 with death as the worst outcome. One thousand eight hundred seventy-two children were randomized, of which 939 were allocated to the conservative oxygenation group (57% female) and 933 to the liberal group (56% female). In the conservative oxygenation group, duration of organ support or death in the first 30 days was significantly lower (probabilistic index, 0.53; 95% CI, 0.50 to 0.55; P = 0.04 [Wilcoxon rank-sum test]) with an adjusted odds ratio of 0.84 (95% CI, 0.72 to 0.99).

Take home message: In this randomized trial including children admitted to pediatric ICUs emergently for invasive ventilation, the conservative oxygenation group had a higher probability of a better outcome regarding organ support and death at 30 days.