Admission Hyperoxia Is a Risk Factor for Mortality in Pediatric Intensive Care*

Numa, Andrew; Aneja, Himanshu; Awad, John; Ravindranathan, Hari; Singh, Puneet; Swil, Kevin; Williams, Gary

doi:10.1097/pcc.0000000000001630

Cited by 24 publications

(50 citation statements)

References 30 publications

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“…The rise in mortality in the patients with greatest Pao 2 did not significantly exceed the nadir in mortality which was present in the Pao 2 188-300 torr (25.1-40.0 kPa) group. In another investigation with 1,447 patients, Numa et al (4) identified an association with rising mortality in a model incorporating an unmodified PIM-3 score. Notably, the PIM-3 score includes the F:P ratio, with the net effect that patients with higher Pao 2 would be expected to have lower PIM-3 (expected mortality) (16).…”

Section: Discussionmentioning

confidence: 98%

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Early Hyperoxemia and Outcome Among Critically Ill Children

Ramgopal

Dezfulian

Hickey

et al. 2020

Pediatric Critical Care Medicine

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Section: Discussionmentioning

confidence: 98%

“…Previous studies evaluating the association between presenting hyperoxemia and mortality among critically ill children performed adjustment with uncalibrated measures of illness severity (4,8). Such severity of illness requires recalibration before application to singlecenter data (10,11).…”

mentioning

confidence: 99%

Early Hyperoxemia and Outcome Among Critically Ill Children

Ramgopal

Dezfulian

Hickey

et al. 2020

Pediatric Critical Care Medicine

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“…18,19,20,21,22 In contrast, 2 large observational studies identified an association between presenting hyperoxemia and mortality among diagnostically diverse cohorts of critically ill children. 23,24…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Key Points Question Is severe hyperoxemia (arterial oxygen tension ≥300 mm Hg) associated with mortality among critically ill children? Findings In this cohort study of 23 719 intensive care encounters from 2009 to 2018 at a children’s hospital, 6250 patients had at least 1 measured arterial oxygen tension value. After adjusting for covariates, severe hyperoxemia appeared to be independently associated with in-hospital mortality, and a stepwise increase in the adjusted odds of mortality was observed with more episodes of severe hyperoxemia. Meaning Severe hyperoxemia appeared to be associated with mortality in a large, single-center cohort of critically ill children; prospective data are needed to assess causality.

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“…Expert opinion has suggested that extreme hyperoxemia may be an indirect measurement of patients undergoing brain death testing or being assessed for organ donation eligibility ( 4 ). However, as relatively few PICU patients undergo brain death testing within 24 hours of admission, the findings of our sensitivity analysis, combined with prior studies of the impact of early hyperoxemia, would suggest this is less likely ( 6 , 7 ).…”

Section: Discussionmentioning

confidence: 86%

“…Because prior work has suggested a parabolic (“U-shaped”) relationship between Pa o 2 and mortality ( 5 , 6 ), we performed a Box-Tidwell test. We developed a multivariable logistic regression model of predicted mortality, with a random effect for hospital, and plotted the expected and actual mortalities of patients grouped by differing maximum Pa o 2 values using bin widths of 100 mm Hg.…”

Section: Methodsmentioning

confidence: 99%

Maximum Pao 2 in the First 72 Hours of Intensive Care Is Associated With Risk-Adjusted Mortality in Pediatric Patients Undergoing Mechanical Ventilation

Pelletier

Ramgopal

et al. 2020

Critical Care Explorations

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A relationship between Pa o 2 and mortality has previously been observed in single-center studies. We performed a retrospective cohort study of the Pediatric Health Information System plus database including patients less than or equal to 21 years old admitted to a medical or cardiac ICU who received invasive ventilation within 72 hours of admission. We trained and validated a multivariable logistic regression mortality prediction model with very good discrimination ( C -statistic, 0.86; 95% CI, 0.79–0.92; area under the precision-recall curve, 0.39) and acceptable calibration (standardized mortality ratio, 0.96; 95% CI, 0.75–1.23; calibration belt p = 0.07). Maximum Pa o 2 measurements demonstrated a parabolic (“U-shaped”) relationship with PICU mortality (Box-Tidwell p < 0.01). Maximum Pa o 2 was a statistically significant predictor of risk-adjusted mortality (standardized odds ratio, 1.27; 95% CI, 1.23–1.32; p < 0.001). This analysis is the first multicenter pediatric study to identify a relationship between the extremes in Pa o 2 values and PICU mortality. Clinicians should remain judicious in the use of oxygen when caring for children.

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Admission Hyperoxia Is a Risk Factor for Mortality in Pediatric Intensive Care*

Abstract: In this single-center study, hyperoxia at admission to the PICU was highly correlated with increased risk-adjusted mortality. Further investigation of these observations in a large multicenter cohort is warranted.

Cited by 24 publications

References 30 publications

Early Hyperoxemia and Outcome Among Critically Ill Children

Early Hyperoxemia and Outcome Among Critically Ill Children

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

Maximum Pao 2 in the First 72 Hours of Intensive Care Is Associated With Risk-Adjusted Mortality in Pediatric Patients Undergoing Mechanical Ventilation

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