Hyperoxemia among Pediatric Intensive Care Unit Patients Receiving Oxygen Therapy

Abstract

Supratherapeutic oxygen levels consistently cause oxygen toxicity in the lungs and other organs. The prevalence and severity of hyperoxemia among pediatric intensive care unit (PICU) patients remain unknown. This was the first study to examine the prevalence and duration of hyperoxemia in PICU patients receiving oxygen therapy. This is a retrospective chart review. This was performed in a setting of 36-bed PICU in a quaternary-care children's hospital. All the patients were children aged <18 years, admitted to the PICU for ≥24 hours, receiving oxygen therapy for ≥12 hours who had at least one arterial blood gas during this time.

There was no intervention. Of 5,251 patients admitted to the PICU, 614 were included in the study. On average, these patients received oxygen therapy for 91% of their time in the PICU and remained hyperoxemic, as measured by pulse oximetry, for 65% of their time on oxygen therapy. Patients on oxygen therapy remained hyperoxemic for a median of 38 hours per patient and only 1.1% of patients did not experience any hyperoxemia. Most of the time (87.5%) patients received oxygen therapy through a fraction of inspired oxygen (FiO₂)-adjustable device. Mean FiO₂ on noninvasive support was 0.56 and on invasive support was 0.37. Mean partial pressure of oxygen (PaO₂) on oxygen therapy was 108.7 torr and 3,037 (42.1%) of PaO₂ measurements were >100 torr. Despite relatively low FiO₂, PICU patients receiving oxygen therapy are commonly exposed to prolonged hyperoxemia, which may contribute to ongoing organ injury.

Keywords

hyperoxemia - oxygen therapy - oxygen toxicity - mechanical ventilation

Publication History

Received: 15 September 2021

Accepted: 09 November 2021

Article published online:
23 December 2021

• References

• 1 Tretter V, Zach ML, Böhme S, Ullrich R, Markstaller K, Klein KU. Investigating disturbances of oxygen homeostasis: from cellular mechanisms to the clinical practice. Front Physiol 2020; 11: 947
• 2 Kallet RH, Matthay MA. Hyperoxic acute lung injury. Respir Care 2013; 58 (01) 123-141
• 3 Pannu SR. Too much oxygen: hyperoxia and oxygen management in mechanically ventilated patients. Semin Respir Crit Care Med 2016; 37 (01) 16-22
• 4 Caldwell PR, Lee Jr. WL, Schildkraut HS, Archibald ER. Changes in lung volume, diffusing capacity, and blood gases in men breathing oxygen. J Appl Physiol 1966; 21 (05) 1477-1483
• 5 Brugniaux JV, Coombs GB, Barak OF, Dujic Z, Sekhon MS, Ainslie PN. Highs and lows of hyperoxia: physiological, performance, and clinical aspects. Am J Physiol Regul Integr Comp Physiol 2018; 315 (01) R1-R27
• 6 Allen J, Panitch H. Bronchopulmonary dysplasia-A historical perspective. Pediatr Pulmonol 2021; 56 (11) 3478-3489
• 7 Steinhorn RH. Advances in neonatal pulmonary hypertension. Neonatology 2016; 109 (04) 334-344
• 8 Tipple TE, Ambalavanan N. Oxygen toxicity in the neonate: thinking beyond the balance. Clin Perinatol 2019; 46 (03) 435-447
• 9 Saugstad OD, Oei JL, Lakshminrusimha S, Vento M. Oxygen therapy of the newborn from molecular understanding to clinical practice. Pediatr Res 2019; 85 (01) 20-29
• 10 Perez M, Robbins ME, Revhaug C, Saugstad OD. Oxygen radical disease in the newborn, revisited: oxidative stress and disease in the newborn period. Free Radic Biol Med 2019; 142: 61-72
• 11 Girardis M, Busani S, Damiani E. et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA 2016; 316 (15) 1583-1589
• 12 Suzuki S, Eastwood GM, Peck L, Glassford NJ, Bellomo R. Current oxygen management in mechanically ventilated patients: a prospective observational cohort study. J Crit Care 2013; 28 (05) 647-654
• 13 de Graaff AE, Dongelmans DA, Binnekade JM, de Jonge E. Clinicians' response to hyperoxia in ventilated patients in a Dutch ICU depends on the level of FiO2. Intensive Care Med 2011; 37 (01) 46-51
• 14 Dennis D, Torre L, Baker S, Hebden-Todd T. A snapshot of the oxygenation of mechanically ventilated patients in one Australian intensive care unit. Anaesth Intensive Care 2017; 45 (03) 359-364
• 15 Numa A, Aneja H, Awad J. et al. Admission hyperoxia is a risk factor for mortality in pediatric intensive care. Pediatr Crit Care Med 2018; 19 (08) 699-704
• 16 Guerra-Wallace MM, Casey III FL, Bell MJ, Fink EL, Hickey RW. Hyperoxia and hypoxia in children resuscitated from cardiac arrest. Pediatr Crit Care Med 2013; 14 (03) e143-e148
• 17 Ramgopal S, Dezfulian C, Hickey RW. et al. Association of severe hyperoxemia events and mortality among patients admitted to a pediatric intensive care unit. JAMA Netw Open 2019; 2 (08) e199812
• 18 Ferguson LP, Durward A, Tibby SM. Relationship between arterial partial oxygen pressure after resuscitation from cardiac arrest and mortality in children. Circulation 2012; 126 (03) 335-342
• 19 Ray S, Rogers L, Raman S, Peters MJ. Oxy-PICU investigators. Liberal oxygenation in paediatric intensive care: retrospective analysis of high-resolution SpO₂ data. Intensive Care Med 2017; 43 (01) 146-147
• 20 O'Driscoll BR, Howard LS, Earis J, Mak V. British Thoracic Society Emergency Oxygen Guideline Group. BTS Emergency Oxygen Guideline Development Group. BTS guidelines for oxygen use in adults in healthcare and emergency settings. Thorax 2017; 72 (S1): ii1-ii90
• 21 van den Boom W, Hoy M, Sankaran J. et al. The search for optimal oxygen saturation targets in critically ill patients. Chest 2020; 157 (03) 566-573
• 22 Durlinger EMJ, Spoelstra-de Man AME, Smit B. et al. Hyperoxia: at what level of SpO₂ is a patient safe? A study in mechanically ventilated ICU patients. J Crit Care 2017; 39: 199-204
• 23 R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing 2019: Vienna, Austria
• 24 Wickham H, Averick M, Bryan J. et al. Welcome to the Tidyverse. J Open Source Softw 2019; 4 (43) 1686
• 25 Raman S, Prince NJ, Hoskote A, Ray S, Peters MJ. Admission PaO2 and mortality in critically ill children: a cohort study and systematic review. Pediatr Crit Care Med 2016; 17 (10) e444-e450
• 26 Brower RG, Lanken PN, MacIntyre N. et al; National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004; 351 (04) 327-336
• 27 Morozoff E, Smyth JA, Saif M. Applying computer models to realize closed-loop neonatal oxygen therapy. Anesth Analg 2017; 124 (01) 95-103
• 28 Grimaldi D, Hraiech S, Boutin E. et al; SRLF Trial Group. Hypoxemia in the ICU: prevalence, treatment, and outcome. Ann Intensive Care 2018; 8 (01) 82