Excessive Oxygen Supplementation in the First Day of Mechanical Ventilation Is Associated With Multiple Organ Dysfunction and Death in Critically Ill Children*

Balcarcel, Daniel R; Coates, Bria M.; Chong, Grace; Sanchez-Pinto, L. Nelson

doi:10.1097/pcc.0000000000002861

Cited by 18 publications

(30 citation statements)

References 39 publications

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“…This discrepancy in exposure is likely attributable to intrapulmonary shunting, as observed in acute respiratory distress syndrome, a common complication of severe bronchiolitis ( 16 ). This highlights that we should not focus solely on Pa o 2 to assess oxygen toxicity ( 5 ), as this marker fails to address potential adverse effects of high pulmonary exposure in patients with injured lungs ( 4 , 9 , 10 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

“…High-dose pulmonary exposure and overuse of oxygen have previously been associated with worse outcome independent of disease severity ( 10 , 17 , 22 ). This partially aligns with our findings, as initial F io 2 levels were associated with prolonged disease, but for possible overuse, we observed an association with outcome only in sensitivity analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Pa o 2 greater than 100 Torr (> 13.3 kPa) was defined as supraphysiological and greater than 248 Torr (> 33 kPa) as severe hyperoxemia ( 5 ). To quantify possible excessive oxygen exposure, the cumulative excessive oxygen exposure score (CEE) was calculated ( 10 ). Oxygen administered above room air when peripheral oxygen saturation (Sp o 2 ) was greater than or equal to 97% was scored as excessive ( 11 , 12 ).…”

Section: Methodsmentioning

confidence: 99%

“…Oxygen administered above room air when peripheral oxygen saturation (Sp o 2 ) was greater than or equal to 97% was scored as excessive ( 11 , 12 ). A sensitivity analysis was included with Sp o 2 greater than or equal to 95% (eMethods, http://links.lww.com/PCC/C278 ) ( 10 ). CEE of 0.17–0.25 was defined as high and greater than 0.25 as severe exposure ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

“…A sensitivity analysis was included with Sp o 2 greater than or equal to 95% (eMethods, http://links.lww.com/PCC/C278 ) ( 10 ). CEE of 0.17–0.25 was defined as high and greater than 0.25 as severe exposure ( 10 ). We also assessed the healthcare worker’s response on F io 2 settings if Sp o 2 was greater than or equal to 97% by assessing any change in F io 2 during the next hour of IMV.…”

Section: Methodsmentioning

confidence: 99%

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The Local and Systemic Exposure to Oxygen in Children With Severe Bronchiolitis on Invasive Mechanical Ventilation: A Retrospective Cohort Study

Lilien

Sonnaville

Woensel

et al. 2022

Pediatric Critical Care Medicine

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OBJECTIVES: Oxygen supplementation is a cornerstone treatment in critically ill children with bronchiolitis in the PICU. However, potential deleterious effects of high-dose oxygen are well-known. In this study, we aim to describe the pulmonary (local) and arterial (systemic) oxygen exposure over the duration of invasive mechanical ventilation (IMV) in children with severe bronchiolitis. Our secondary aim was to estimate potentially avoidable exposure to high-dose oxygen in these patients. DESIGN: Retrospective cohort study. SETTING: Single-center, tertiary-care PICU. PATIENTS: Children younger than 2 years old admitted to the PICU for severe bronchiolitis receiving IMV. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Hourly measurements of F io 2 and peripheral oxygen saturation (Sp o 2 ), and arterial blood gas data were collected up to day 10 of IMV. A total of 24,451 hours of IMV were observed in 176 patients (median age of 1.0 mo [interquartile range (IQR), 1.0–2.3 mo]). The pulmonary exposure to oxygen was highest during the first day of IMV (median time-weighted average [TWA]–F io 2 0.46 [IQR, 0.39–0.53]), which significantly decreased over subsequent days. The systemic exposure to oxygen was relatively low, as severe hyperoxemia (TWA–Pa o 2 > 248 Torr [> 33 kPa]) was not observed. However, overuse of oxygen was common with 52.3% of patients ( n = 92) having at least 1 day of possible excessive oxygen exposure and 14.8% ( n = 26) with severe exposure. Furthermore, higher oxygen dosages correlated with increasing overuse of oxygen (r repeated measures , 0.59; 95% CI, 0.54–0.63). Additionally, caregivers were likely to keep F io 2 greater than or equal to 0.50 when Sp o 2 greater than or equal to 97%. CONCLUSIONS: Moderate to high-dose pulmonary oxygen exposure and potential overuse of oxygen were common in this cohort of severe bronchiolitis patients requiring IMV; however, this was not accompanied by a high systemic oxygen burden. Further studies are needed to determine optimal oxygenation targets to prevent overzealous use of oxygen in this vulnerable population.

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