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Observational Study
. 2019 Aug 2;2(8):e199812.
doi: 10.1001/jamanetworkopen.2019.9812.

Association of Severe Hyperoxemia Events and Mortality Among Patients Admitted to a Pediatric Intensive Care Unit

Sriram Ramgopal  1 , Cameron Dezfulian  2   3 , Robert W Hickey  1 , Alicia K Au  2   3   4 , Shekhar Venkataraman  1   2 , Robert S B Clark  1   2   3   4 , Christopher M Horvat  1   2   3   4
Affiliations
Observational Study

Association of Severe Hyperoxemia Events and Mortality Among Patients Admitted to a Pediatric Intensive Care Unit

Sriram Ramgopal et al. JAMA Netw Open. .

Abstract

Importance: A high Pao2, termed hyperoxemia, is postulated to have deleterious health outcomes. To date, the association between hyperoxemia during the ongoing management of critical illness and mortality has been incompletely evaluated in children.

Objective: To examine whether severe hyperoxemia events are associated with mortality among patients admitted to a pediatric intensive care unit (PICU).

Design, setting, and participants: A retrospective cohort study was conducted over a 10-year period (January 1, 2009, to December 31, 2018); all 23 719 PICU encounters at a quaternary children's hospital with a documented arterial blood gas measurement were evaluated.

Exposures: Severe hyperoxemia, defined as Pao2 level greater than or equal to 300 mm Hg (40 kPa).

Main outcomes and measures: The highest Pao2 values during hospitalization were dichotomized according to the definition of severe hyperoxemia and assessed for association with in-hospital mortality using logistic regression models incorporating a calibrated measure of multiple organ dysfunction, extracorporeal life support, and the total number of arterial blood gas measurements obtained during an encounter.

Results: Of 23 719 PICU encounters during the inclusion period, 6250 patients (13 422 [56.6%] boys; mean [SD] age, 7.5 [6.6] years) had at least 1 measured Pao2 value. Severe hyperoxemia was independently associated with in-hospital mortality (adjusted odds ratio [aOR], 1.78; 95% CI, 1.36-2.33; P < .001). Increasing odds of in-hospital mortality were observed with 1 (aOR, 1.47; 95% CI, 1.05-2.08; P = .03), 2 (aOR, 2.01; 95% CI, 1.27-3.18; P = .002), and 3 or more (aOR, 2.53; 95% CI, 1.62-3.94; P < .001) severely hyperoxemic Pao2 values obtained greater than or equal to 3 hours apart from one another compared with encounters without hyperoxemia. A sensitivity analysis examining the hypothetical outcomes of residual confounding indicated that an unmeasured binary confounder with an aOR of 2 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 (aOR of severe hyperoxemia, 1.31; 95% CI, 0.99-1.72).

Conclusions and relevance: Greater numbers of severe hyperoxemia events appeared to be associated with increased mortality in this large, diverse cohort of critically ill children, supporting a possible exposure-response association between severe hyperoxemia and outcome in this population. Although further prospective evaluation appears to be warranted, this study's findings suggest that guidelines for ongoing management of critically ill children should take into consideration the possible detrimental effects of severe hyperoxemia.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Dezfulian reported grants from Mallinckrodt Pharmaceuticals outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Proportions of Observed and Estimated Mortality for Included Patients Grouped by Maximum Pao2 Level During Pediatric Intensive Care Unit Hospitalization
Modified Pediatric Logistic Organ Dysfunction-2 score was used as the measure.
See this image and copyright information in PMC

References

    1. O’Driscoll BR, Howard LS, Earis J, Mak V; British Thoracic Society Emergency Oxygen Guideline Group; BTS Emergency Oxygen Guideline Development Group . BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72(suppl 1):-. doi:10.1136/thoraxjnl-2016-209729 - DOI - PMC - PubMed
    1. Hale KE, Gavin C, O’Driscoll BR. Audit of oxygen use in emergency ambulances and in a hospital emergency department. Emerg Med J. 2008;25(11):773-776. doi:10.1136/emj.2008.059287 - DOI - PubMed
    1. Smith JL. The pathological effects due to increase of oxygen tension in the air breathed. J Physiol. 1899;24(1):19-35. doi:10.1113/jphysiol.1899.sp000746 - DOI - PMC - PubMed
    1. Nagato AC, Bezerra FS, Lanzetti M, et al. . Time course of inflammation, oxidative stress and tissue damage induced by hyperoxia in mouse lungs. Int J Exp Pathol. 2012;93(4):269-278. doi:10.1111/j.1365-2613.2012.00823.x - DOI - PMC - PubMed
    1. Fracica PJ, Knapp MJ, Piantadosi CA, et al. . Responses of baboons to prolonged hyperoxia: physiology and qualitative pathology. J Appl Physiol (1985). 1991;71(6):2352-2362. doi:10.1152/jappl.1991.71.6.2352 - DOI - PubMed

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