A recent study conducted by researchers at UCL and Great Ormond Street Hospital has found that reducing oxygen levels in critically ill children on mechanical ventilators in intensive care can potentially save numerous young lives each year. The study, published in The Lancet, also suggests that lower oxygen levels could decrease the number of days children spend on organ support machines, resulting in an annual cost savings of £20 million for the NHS.
The lead author of the study, Professor Mark Peters, explained that administering the minimum safe dose of any treatment in intensive care often leads to the best outcomes. The researchers wanted to test this approach with oxygen and discovered a small yet significant benefit when using lower oxygen targets. Professor Peters believes that implementing this approach has the potential to enhance outcomes and reduce healthcare costs not only in the UK but also globally, especially in countries where oxygen is scarce or during situations when there is a sudden surge in oxygen demand.
In the UK alone, approximately 20,000 children are admitted to intensive care annually, with about 75% of them receiving additional oxygen through mechanical ventilators. Oxygen is a commonly used emergency treatment, and medical professionals adjust the amount of oxygen administered based on the patient’s blood oxygen levels. While extremely low oxygen levels can be harmful, recent research suggests that slightly lower than normal levels may actually be the optimal target for severely ill individuals.
The Oxy-PICU study, which is the largest randomized controlled trial ever conducted in pediatric intensive care units (PICUs), involved researchers from UCL, Great Ormond Street Hospital, the Intensive Care National Audit & Research Center (ICNARC), and the Pediatric Critical Care Society Study Group (PCCS-SG). A total of 2,040 children from 15 NHS PICUs across England and Scotland were recruited for the study. Each child required mechanical ventilation and additional oxygen upon admission to the PICU.
The children, ranging from newborns to 16-year-olds, were randomly assigned to either receive oxygen at the standard target level (saturation SpO2 > 94%) or at a reduced target level (SpO2 88%–92%). The percentages indicate the proportion of blood oxygen-carrying capacity being utilized.
The results of the study showed that children who received lower levels of oxygen were 6% more likely to experience better outcomes, either in terms of survival or the number of days spent on organ support machines.
If the approach of using lower oxygen levels were to be implemented across the NHS, the researchers estimate that it could potentially save 50 lives, reduce the number of ICU bed days by 6,000, and result in an annual cost savings of £20 million in the UK alone.
Lauran O’Neill, a Senior Critical Care Nurse at Great Ormond Street Hospital, emphasized that this study is a major milestone, as it was nurse-led and conducted right at the bedside as part of normal clinical care. O’Neill highlighted that every child admitted to the intensive care unit was screened for potential inclusion in the study.
Professor Marian Knight, Scientific Director for NIHR Infrastructure, expressed the significance of this nurse-led study, which challenges the current accepted practice of providing oxygen to children in intensive care and could have a global impact. Professor Knight expressed pride in supporting Professor Peters and his team through the Health Technology Assessment program, the Biomedical Research Center at Great Ormond Street Hospital, and the remarkable research nursing staff at NIHR.
The study also highlighted the personal story of two-year-old Noah Karunananthan, who was diagnosed with leukemia in May 2022. Noah’s parents consented to him participating in the Oxy-PICU trial during his stay in the ICU at Great Ormond Street Hospital. Noah underwent a brain biopsy to extract a suspected fungal infection and experienced significant recovery afterward. Today, Noah is thriving at nursery, and his parents are proud that they have been able to contribute to research that may benefit other children and families in similar situations.
In conclusion, the study’s findings suggest that reducing oxygen levels for children in intensive care, particularly those on mechanical ventilators, can potentially save lives and reduce the number of days spent on organ support machines. The implementation of this approach could also lead to substantial cost savings for healthcare systems. Further research and implementation of these findings could have a significant impact on improving outcomes for severely ill children worldwide.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
