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Lower oxygen targets show benefit for critically ill children in intensive care

Reducing oxygen levels in critically ill children on mechanical ventilators in intensive care could save 50 lives each year, according to a new study by Great Ormond Street Hospital (GOSH) and University College London.

The Oxy-PICU study, published in The Lancet, is the largest randomised controlled trial ever conducted in paediatric intensive care units (PICUs).

The researchers recruited 2,040 children from 15 NHS PICUs across England and Scotland. Each of the children required a mechanical ventilator and extra oxygen on admission to the PICU.

The children, who ranged from newborn up to 16 years, were randomly allocated to one of two groups: they received oxygen to the standard target level of oxygen (saturation “SpO2” >94%), or a reduced oxygen target (SpO2 88-92%).

The researchers found that the 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.

In the UK, around 20,000 children are admitted to intensive care each year and roughly 75% will receive additional oxygen through a ventilator.

If the study were to be scaled up, the researchers anticipate that this approach could save 50 lives, free up 6,000 ICU bed days and save £20m annually in the UK alone.

Professor Mark Peters, consultant paediatric intensivist at GOSH, professor of paediatric intensive care at UCL Great Ormond St Institute of Child Health, and lead author on the study, 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.’

Lauran O’Neill, senior critical care research nurse at GOSH, said: ‘This is a major milestone study, which was nurse-led, with research taking place at the bedside as part of normal clinical care. It’s a great example of a research-hospital vision as every child admitted to ICU was screened for inclusion into the study.

‘Although GOSH teams were managing the study and a major recruiter, undertaking the research process was part of the standard of care for many emergency teams across the country – so training and education was the focus. We had to work well together across all collaborating hospitals to deliver this huge success for our patients.’

The Oxy-PICU study also includes researchers from the Intensive Care National Audit & Research Centre and the Paediatric Critical Care Society Study Group.

It is funded by the National Institute for Health and Care Research (NIHR)’s Health Technology Assessment programme and supported by the NIHR’s Biomedical Research Centres at GOSH and UCLH.

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