Ethnicity and Observed Oxygen Saturations, Fraction of Inspired Oxygen, and Clinical Outcomes: A Post Hoc Analysis of the Oxy-PICU Trial of Conservative Oxygenation

Jones GAL 1 , Wiegand M 2 , Ray S 1 , Gould DW 3 , Agbeko R 4 , Giallongo E 3 Show all authors , Charles WN 3 , Orzol M 3 , O'Neill L 1 , Lampro L 3 , Lillie J 5 , Pappachan J 6 , Ramnarayan P 7 , Harrison DA 3 , Mouncey PR 3 , Peters MJ 1 , Oxy-PICU investigators of the pediatric Critical Care Society Study Group

Affiliations 

  • 1 Paediatric ICU, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR Biomedical Research Centre, London, United Kingdom
  • 2 Department of Statistical Science, University College London, London, United Kingdom
  • 3 Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, United Kingdom
  • 4 Department of Paediatric Intensive Care, Great North Children's Hospital, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
  • 5 Paediatric ICU, Evelina London Children's Hospital, London United Kingdom
  • 6 Paediatric ICU, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
  • 7 Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
Pediatr Crit Care Med, 2024 Jul 19.
PMID: 39028216 DOI: 10.1097/PCC.0000000000003583

Abstract

OBJECTIVES: A conservative oxygenation strategy, targeting peripheral oxygen saturations (Spo2) between 88% and 92% in mechanically ventilated children in PICU, was associated with a shorter duration of organ support and greater survival compared with Spo2 greater than 94% in our recent Oxy-PICU trial. Spo2 monitors may overestimate arterial oxygen saturation (Sao2) in patients with higher levels of skin pigmentation compared with those with less skin pigmentation. We investigated if ethnicity was associated with changes in distributions of Spo2 and Fio2 and outcome.

DESIGN: Post hoc analysis of a pragmatic, open-label, multicenter randomized controlled trial.

SETTING: Fifteen PICUs across the United Kingdom and Scotland.

PATIENTS: Children aged 38 weeks corrected gestational age to 15 years accepted to a participating PICU as an unplanned admission and receiving invasive mechanical ventilation with supplemental oxygen for abnormal gas exchange.

METHODS: Hierarchical regression models for Spo2 and Fio2, and ordinal models for the primary trial outcome of a composite of the duration of organ support at 30 days and death, were used to examine the effects of ethnicity, accounting for baseline Spo2, Fio2, and mean airway pressure and trial allocation.

MEASUREMENTS AND MAIN RESULTS: Ethnicity data were available for 1577 of 1986 eligible children, 1408 (89.3%) of which were White, Asian, or Black. Spo2 and Fio2 distributions did not vary according to Black or Asian ethnicity compared with White children. The trial primary outcome measure also did not vary significantly with ethnicity. The point estimate for the treatment effect of conservative oxygenation in Black children was 0.64 (95% CI, 0.33-1.25) compared with 0.84 (0.68-1.04) in the overall trial population.

CONCLUSIONS: These data do not suggest that the association between improved outcomes and conservative oxygenation strategy in mechanically ventilated children in PICU is modified by ethnicity.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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