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Mortality risk higher with severe hyperoxemia in pediatric ICU

Critically ill children who experience severe hyperoxemia in the pediatric ICU may have a higher risk for in-hospital mortality, according to data published in JAMA Network Open.

In the retrospective cohort study conducted over 10 years in a pediatric ICU, the researchers found an independent association between severe hyperoxemia, defined as a partial pressure of oxygen (PaO₂) in the arterial blood of at least 300 mm Hg, and in-hospital mortality (adjusted OR = 1.78; 95% CI, 1.36-2.33).

When compared with patients without severe hyperoxemia, the odds for in-hospital mortality were significantly higher for those with at least one severely hyperoxemic PaO₂ value (aOR = 1.47; 95% CI, 1.05-2.08) and more than twice as high for those with two (aOR = 2.01; 95% CI, 1.27-3.18) or three or more severely hyperoxemic PaO₂ values (aOR = 2.53; 95% CI, 1.62-3.94).

Additionally, results from a sensitivity analysis evaluating possible residual confounding showed that an unmeasured binary variable would have to be present in 37% of the encounters with severe hyperoxemia and 0% of the remaining cohort to fail to reject the null hypothesis.

The study included 23,719 encounters in the pediatric ICU in a quaternary children’s hospital in western Pennsylvania from 2009 to 2018. Of these encounters, 6,250 patients (mean age, 7.5 years) had at least one available PaO₂ value.

Critically ill children who experience severe hyperoxemia in the pediatric ICU may have a higher risk for in-hospital mortality, according to data published in JAMA Network Open.

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“These findings, while in need of prospective validation, seem to support an association between severe hyperoxemia and poor outcomes among critically ill children and adolescents,” the researchers wrote. “Future guidelines for the ongoing support of critically ill children may account for the possible deleterious effects of supratherapeutic oxygen levels in this population.” – by Melissa Foster

Disclosures: This study was supported by the Children’s Hospital of Pittsburgh Trust Young Investigator Award and in part by the NIH. One author reports he has received grants from Mallinckrodt Pharmaceuticals. All other authors report no relevant financial disclosures.