Imagine your child is in intensive care and needs a machine to help them breathe. Doctors have to decide what level of oxygen in their blood to aim for. Should they aim high, or could a slightly lower target be just as safe and maybe even better? A recent trial with 178 critically ill children compared two approaches. One group had a 'conservative' target of 88-92% oxygen saturation, while the other had the more 'conventional' target of 94-99%. The most important finding was that the lower target was just as safe. Death rates at 7 and 30 days, the need for other organ support, and the length of the hospital stay were all similar between the two groups. But the children in the conservative oxygen group spent significantly less time on breathing support—4 days versus 6 days—and needed far less total oxygen therapy. The study also checked a marker of potential oxygen-related stress in the blood and found no difference. The bottom line: for these critically ill children, using a slightly lower oxygen target didn't harm them and helped them get off respiratory support quicker.
For critically ill kids on oxygen, aiming lower may mean less time on breathing support
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What this means for you:
Aiming for slightly lower oxygen levels was safe for critically ill kids and cut their time on breathing support. What this means for you:
Aiming for slightly lower oxygen levels was safe for critically ill kids and cut their time on breathing support. View Original Abstract ↓
The objective of this study is to compare conservative versus conventional oxygen saturation targets on clinical outcomes in critically ill children requiring respiratory support. This open label randomized controlled trial was conducted in a tertiary care pediatric intensive care unit between May 2023 and November 2024. Children aged 1 month to 15 years requiring invasive or noninvasive oxygen therapy were randomized to conservative (SpO₂ 88-92%) or conventional (SpO₂ 94-99%) oxygen saturation targets. Fraction of inspired oxygen was titrated to maintain assigned targets. The primary outcome was a composite of death and organ support at 30 days. Secondary outcomes included mortality at 7 and 30 days, duration of respiratory support and oxygen therapy, length of PICU and hospital stay, and oxidative stress assessed by serum malondialdehyde (MDA) at baseline and day 7. A total of 178 children were randomized. Baseline characteristics and illness severity were comparable between groups. The median composite outcome score was 8 (IQR 4-20.25) in the conservative group and 10 (IQR 5-20) in the conventional group (p = 0.15). Duration of respiratory support (4 vs 6 days; p = 0.003) and oxygen therapy (8 vs 100 h; p < 0.001) were significantly lower in the conservative group. Mortality at 7 and 30 days, organ support days, length of stay, and MDA levels were similar.Conclusion: Conservative oxygen saturation targets (88-92%) were safe and resulted in similar mortality and organ dysfunction compared with conventional targets, with reduced duration of respiratory support and oxygen therapy. Larger multicenter trials are needed to confirm these findings.Trial registration: The trial is registered in Clinical Trial Registry India (CTRI) (registration number CTRI/2023/11/060105, date of registration 21/11/2023.