Incidence of hyperoxia and excess of oxygen use in critically ill pediatric patients
Abstract
Introduction: Oxygen therapy is a crucial aspect of quality care in the pediatric Intensive Care unit. It is not only necessary for preventing hypoxia but also important for reducing the burden of labored breathing in a child maintaining saturation at the cost of a higher basal metabolic rate. To determine the incidence of hyperoxia in patients receiving supplemental oxygen therapy in a pediatric intensive care setting.
Methodology: A cross-sectional prospective study was conducted at the pediatric intensive care unit of Shifa International Hospital from November 2022 to October 2023. A total of 137 patients were included in the study. Consecutive non-probability sampling was used for patients who matched the inclusion and exclusion criteria. Data regarding demographic and clinical factors was collected and evaluated using SPSS 23. The incidence of hyperoxia and its relationship to mortality, organ dysfunction, mode of ventilation, and length of stay was determined.
Results: The mean age of the patients participating in the study was 4.97 ± 4.35 years and 101 (73.7%) were males. Mean fractional inspired oxygen, saturation, and partial pressure of oxygen were 0.37 ±0.19, 94.58 ±3.20, and 102.77 ±21.95 mmHg respectively. The overall incidence of hyperoxia was 9.5%. There was no statistically significant difference in mode of ventilation, organ dysfunction, and length of stay when compared between those who had hyperoxia and those who did not.
Conclusion: The study concludes that the overall incidence of hyperoxia remains low at 9.5% as only 13 out of 137 patients experienced it.
Downloads
References
World Health Organization. Updated guideline: pediatric emergency triage, assessment and treatment: care of critically ill children. World Health Organization; 2016.
Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner Jr BL, et al. Part 4: Pediatric Basic and advanced life support: 2020 American Heart Association guidelines for Cardiopulmonary Resuscitation and emergency cardiovascular care. Circulation. 2020; 142(16_Suppl_2):S469-523.
DOI: https://doi.org/10.1161/CIR.0000000000000901.
Ralston SL, Lonhart JA, Schroeder AR. Too much of a good thing: Hyperoxia and pediatric respiratory illnesses. Pediatrics. 2020; 146(2) ):e20193343
DOI: https://doi.org/10.1542/peds.2019-3343
Young PJ, Frei D. Oxygen therapy for critically Ill and post-operative patients. J Anaesth. 2021; 35(6):928-38.
DOI: https://doi.org/10.1007/s00540-021-02996-8
Carr AC, Spencer E, Mackle D, Hunt A, Judd H, Mehrtens J, et al. The effect of conservative oxygen therapy on systemic biomarkers of oxidative stress in critically ill patients. Free Radic Biol Med. 2020; 160:13-8.
DOI: https://doi.org/10.1016/j.freeradbiomed.2020.06.018
Thébaud B, Goss KN, Laughon M, Whitsett JA, Abman SH, Steinhorn RH, et al. Bronchopulmonary dysplasia. Nat Rev Dis Primers. 2019; 5(1).
DOI: https://doi.org/10.1038/s41572-019-0127-7
Peters MJ. Linking hyperoxia and harm: consequence or merely subsequence?. Pediat Crit Care Med. 2021; 22(5):501-3.
DOI: https://doi.org/10.1097/PCC.0000000000002709
Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, et al. European resuscitation council guidelines 2021: paediatric life support. Resuscitation. 2021; 161:327-87.
DOI: https://doi.org/10.1016/j.resuscitation.2021.02.015
Fayazi AR, Sesia M, Anand KJS. Hyperoxemia among pediatric intensive care unit patients receiving oxygen therapy. J Pediatr Intensive Care. 2021;
DOI: https://doi.org/10.1055/s-0041-1740586
Napolitano N, Berlinski A, Walsh BK, Ginier E, Strickland SL. AARC clinical practice guideline: Management of pediatric patients with oxygen in the acute care setting. Respir Care. 2021; 66(7):1214-23.
DOI: https://doi.org/10.4187/respcare.09006
Cunningham S, Rodriguez A, Adams T, Boyd KA, Butcher I, Enderby B, et al. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomized, equivalence trial. Lancet. 2015; 386(9998):1041-8.
DOI: https://doi.org/10.1016/S0140-6736(15)00163-4
Lilien TA, Groeneveld NS, van Etten-Jamaludin F, Peters MJ, Buysse CMP, Ralston SL, et al. Association of arterial hyperoxia with outcomes in critically ill children: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Netw Open. 2022; 5(1):e2142105.
DOI: https://doi.org/10.1001/jamanetworkopen.2021.42105
Raza M, Ali S. Fasting Blood Glucose and Serum Peptide YY levels in Sprague Dawley Rats and its Potential role in Treating Obesity. J Islamic Int Med Coll. J. 2017; 12(2):78-82
ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group, Mackle D, Bellomo R, Bailey M, Beasley R, Deane A, et al. Conservative Oxygen Therapy during Mechanical Ventilation in the ICU. N Engl J Med. 2020; 382(11):989-98.
DOI: https://doi.org/10.1056/NEJMoa1903297
Siemieniuk RAC, Chu DK, Kim LH-Y, Güell-Rous M-R, Alhazzani W, Soccal PM, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ [Internet]. 2018; 4169.
DOI: https://doi.org/10.1136/bmj.k4169
Cohen B, Schacham YN, Ruetzler K, Ahuja S, Yang D, Mascha EJ, et al. Effect of intraoperative hyperoxia on the incidence of surgical site infections: a meta-analysis. Br J Anaesth. 2018; 120(6):1176-86.
DOI: https://doi.org/10.1016/j.bja.2018.02.027
Ferrando C, Aldecoa C, Unzueta C, Belda FJ, Librero J, Tusman G, et al. Effects of oxygen on post-surgical infections during an individualized perioperative open-lung ventilatory strategy: a randomized controlled trial. Br J Anaesth. 2020; 124(1):110-20.
DOI: https://doi.org/10.1016/j.bja.2019.10.009
Burns JP, Sellers DE, Meyer EC, Lewis-Newby M, Truog RD. Epidemiology of death in the PICU at five U.S. teaching hospitals. Crit Care Med. 2014; 42(9):2101-8.
DOI: https://doi.org/10.1097/ccm.0000000000000498
Peters MJ, Jones GA, Wiley D, Wulff J, Ramnarayan P, Ray S, Inwald D, et al. Conservative versus liberal oxygenation targets in critically ill children: the randomised multiple-centre pilot Oxy-PICU trial. Intensive Care Med. 2018; 44:1240-8.
DOI: https://doi.org/10.1007/s00134-018-5232-7
Ketharanathan N, De Jonge RCJ, Klouwen I, Wildschut ED, Reiss IKM, Tibboel D, et al. Hyperoxia in pediatric severe traumatic brain injury (TBI): a comparison of patient classification by cutoff versus cumulative (area-under-the-curve) analysis. Brain Inj. 2020; 34(7):958–64.
DOI: https://doi.org/10.1080/02699052.2020.1765021
Ramgopal S, Dezfulian C, Hickey RW, Au AK, Venkataraman S, Clark RSB, et al. Association of severe hypoxemia events and mortality among patients admitted to a pediatric intensive care unit. JAMA Netw Open. 2019; 2(8):e199812.
Copyright (c) 2024 Journal of Shifa Tameer-e-Millat University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Journal of Shifa Tameer-e-Millat University (JSTMU) is the owner of all copyright to any work published in the journal. Any material printed in JSTMU may not be reproduced without the permission of the editors or publisher. The Journal accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing and/or decision in this journal. The Editorial Board makes every effort to ensure the accuracy and authenticity of material printed in the journal. However, conclusions and statements expressed are views of the authors and do not necessarily reflect the opinions of the Editorial Board or JSTMU.
Content of this journal is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.