The Operating Theatre Journal - Journal - Page 4
Reducing oxygen levels for children in intensive care
will save lives, new study shows
A new landmark NIHR-funded study has found
that reducing oxygen levels in critically ill
children on mechanical ventilators in intensive
care could save tens of young lives each year.
It could also reduce the number of days spent
on machines supporting organs, saving the
NHS £20 million every year.
Common treatment
In the UK, around 20,000 children are
admitted to intensive care each year. Roughly
75% will receive additional oxygen through a
ventilator.
Oxygen is one of the most common treatments
used in emergency situations. Doctors and
nurses adjust oxygen treatment based on how
much oxygen their patient has in their blood.
While very low oxygen levels are harmful,
current research shows that slightly lower
than normal levels may be the best target for
very ill people.
The Oxy-PICU study is the largest randomised
controlled trial ever conducted in paediatric
intensive care units (PICUs). It was led by
researchers from:
• Great Ormond Street Hospital (GOSH)
• University College London (UCL)
• the Intensive Care National Audit & Research
Centre (ICNARC)
• the Paediatric Critical Care Society Study
Group (PCCS-SG)
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 either:
• oxygen to the standard
(saturation “SpO2” >94%)
target
level
• or a reduced oxygen target (SpO2 88-92%)
The percentages refer to the proportion of the
oxygen-carrying capacity of the blood that is
being used.
Wide-ranging bene昀椀t
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.
If the approach was scaled up across the NHS,
it could save 50 lives, 6,000 ICU bed days and
£20 million annually in the UK alone. The
昀椀ndings have been published in The Lancet.
The Oxy-PICU study is funded by the NIHR’s
Health Technology Assessment programme
and supported by the NIHR’s Biomedical
Research Centres at GOSH and UCLH.
Professor Mark Peters, Consultant Paediatric
Intensivist at GOSH and 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.
“This landmark nurse-led study has challenged
the accepted practice for providing oxygen to
children in intensive care in a way that could
have a global impact. We are proud to have
supported Prof Peters and his team through
both our Health Technology Assessment
programme, our Biomedical Research Centre
at GOSH, and with our remarkable NIHR
research nursing staff.”
The Oxy-PICU paper has been published by
The Lancet.
Participating hospitals
• Alder Hey Children’s Hospital, Alder Hey
Children’s NHS Foundation Trust
• Birmingham Children’s Hospital, Birmingham
Women’s and Children’s NHS Foundation
Trust
“We found a small bene昀椀t 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.”
• Bristol Royal Hospital, University Hospitals
Bristol and Weston NHS Foundation Trust
Cross-country collaboration
• King’s College Hospital, London, King’s
College Hospital NHS Foundation Trust
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.”
Professor Marian Knight, Scienti昀椀c Director
for NIHR Infrastructure, said: “The purpose
of all NIHR health and care research is to
save or improve lives in some way, whether
by questioning what we currently do or
introducing new practice.
• Children’s Acute Transport Service, Great
Ormond Street Hospital NHS Trust
• Evelina London, Guy’s and St Thomas’s
Hospital NHS Trust
• Great Ormond Street, Great Ormond Street
Hospital
• John Radcliffe Hospital, Oxford University
Hospitals NHS Foundation Trust
• Leicester Children’s Hospital, University
Hospitals of Leicester NHS Trust
• Nottingham Children’s Hospital, Nottingham
University Hospitals NHS Trust
• Royal Hospital for Children, Greater Glasgow
and Clyde
• Royal Manchester Children’s Hospital,
Manchester NHS Foundation Trust
• Southampton General Hospital, University
Hospital Southampton NHS Foundation Trust
• St George’s University Hospital, St George’s
University Hospitals NHS Foundation Trust
• St Mary’s Hospital, Imperial College NHS
Trust
• The Great North Children’s Hospital,
The Newcastle Upon Tyne Hospitals NHS
Foundation Trust
Published December 2023
The next issue copy deadline, Monday 29th January 2024
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