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Reducing oxygen levels for children in intensive care could save lives

Critically ill children who were given slightly less oxygen had a better recovery in a national study.

Researchers at University Hospital Southampton (UHS) have helped to show that giving slightly lower oxygen levels could improve the survival of children in intensive care.

It could also reduce the number of days these children spend on machines supporting their organs.

The study was supported locally by the paediatric research nursing team at the NIHR Southampton Clinical Research Facility.

Finding the best oxygen level

In the UK, around 20,000 children are admitted to intensive care each year. Around three in four will receive oxygen through a ventilator.

Oxygen is one of the most common treatments used in emergency situations. Doctors and nurses adjust oxygen treatment based on how much oxygen their patient has in their blood.

While very low oxygen levels are harmful, current research shows that slightly lower than normal levels may be the best target for very ill people.

Largest paediatric intensive care trial

The Oxy-PICU study is the largest randomised controlled trial ever conducted in paediatric intensive care units (PICUs). UHS was one of 15 hospitals across England and Scotland involved in the trial.

It was a nurse-led trial, with the research taking place at the bedside as part of normal clinical care. Every child admitted to a PICU was screened for inclusion into the study.

Overall, just over 2,000 children took part from PICUs. They all required a mechanical ventilator and extra oxygen, and ranged from newborn up to 16 years of age.

They were randomly allocated to the standard oxygen saturation target (SpO2 >94%) or slightly a lower level (SpO2 88-92%). The percentages refer to the proportion of the oxygen-carrying capacity of the blood being used.

Life-saving effects

Children who received the lower level of oxygen were 6% more likely to have a better outcome, either in terms of survival or the number of days spent on machines supporting their organs.

If the approach was scaled up across the NHS, it could save 50 lives, 6,000 ICU bed days and £20 million each year in the UK alone. The results have been published in The Lancet.

The study was led by Great Ormond Street Hospital (GOSH), University College London, the Intensive Care National Audit & Research Centre, and the Paediatric Critical Care Society Study Group. It was funded by the NIHR, and supported by NIHR Biomedical Research Centres at GOSH and UCLH.

Professor Mark Peters, Consultant Paediatric Intensivist at GOSH and Professor of Paediatric Intensive Care at UCL Great Ormond St Institute of Child Health, was lead author. He said:

“Giving the minimum safe dose of anything in intensive care appears to generate the best outcomes, so we wanted to test this approach with oxygen.

“We found a small benefit of lower oxygen targets that is unlikely to have been due to chance. But because so many children are treated with oxygen, this has the potential to improve outcomes and reduce healthcare costs in the UK and around the world.

“This could have particular implications in countries where oxygen is a scarce resource, or in situations as we have seen in recent years, where health needs change, and oxygen demand quickly peaks.”

Dr John Pappachan, Consultant in Anaesthetics and Paediatric Intensive Care Medicine at UHS was a co-applicant on the grant and led recruitment in Southampton. He said:

“It was fantastic to be part of this landmark study, the results of which have the potential to change how we administer oxygen to critically ill children in the UK.

“I’d like to say a special thank you to all the families who took part in Southampton. We couldn’t have made this important discovery without you.”


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