PMID- 36661429
OWN - NLM
STAT- MEDLINE
DCOM- 20230124
LR  - 20230205
IS  - 1529-7535 (Print)
IS  - 1529-7535 (Linking)
VI  - 24
IP  - 2
DP  - 2023 Feb 1
TI  - The Local and Systemic Exposure to Oxygen in Children With Severe Bronchiolitis 
      on Invasive Mechanical Ventilation: A Retrospective Cohort Study.
PG  - e115-e120
LID - 10.1097/PCC.0000000000003130 [doi]
AB  - 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 Fio2 and peripheral oxygen saturation 
      (Spo2), 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]-Fio2 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-Pao2 > 
      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 (rrepeated measures, 0.59; 
      95% CI, 0.54-0.63). Additionally, caregivers were likely to keep Fio2 greater 
      than or equal to 0.50 when Spo2 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.
CI  - Copyright (c) 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on 
      behalf of the Society of Critical Care Medicine and the World Federation of 
      Pediatric Intensive and Critical Care Societies.
FAU - Lilien, Thijs A
AU  - Lilien TA
AD  - Department of Pediatric Intensive Care Medicine, Emma Children's Hospital, 
      Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
FAU - de Sonnaville, Eleonore S V
AU  - de Sonnaville ESV
FAU - van Woensel, Job B M
AU  - van Woensel JBM
FAU - Bem, Reinout A
AU  - Bem RA
LA  - eng
PT  - Journal Article
DEP - 20221207
PL  - United States
TA  - Pediatr Crit Care Med
JT  - Pediatric critical care medicine : a journal of the Society of Critical Care 
      Medicine and the World Federation of Pediatric Intensive and Critical Care 
      Societies
JID - 100954653
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Humans
MH  - Child
MH  - Child, Preschool
MH  - *Respiration, Artificial
MH  - Oxygen
MH  - Retrospective Studies
MH  - *Bronchiolitis/therapy
MH  - Hospitalization
PMC - PMC9848215
COIS- Dr. Lilien received funding through a PhD scholarship (Academic Medical Center 
      Graduate School, Amsterdam UMC) through which this study and previous work was 
      partly funded and from a KNAW Ter Meulen Grant/KNAW Medical Sciences Fund (Royal 
      Netherlands Academy of Arts & Sciences). The remaining authors have disclosed 
      that they do not have any potential conflicts of interest.
EDAT- 2023/01/21 06:00
MHDA- 2023/01/25 06:00
PMCR- 2023/01/18
CRDT- 2023/01/20 09:12
PHST- 2023/01/20 09:12 [entrez]
PHST- 2023/01/21 06:00 [pubmed]
PHST- 2023/01/25 06:00 [medline]
PHST- 2023/01/18 00:00 [pmc-release]
AID - 00130478-202302000-00020 [pii]
AID - 10.1097/PCC.0000000000003130 [doi]
PST - ppublish
SO  - Pediatr Crit Care Med. 2023 Feb 1;24(2):e115-e120. doi: 
      10.1097/PCC.0000000000003130. Epub 2022 Dec 7.