Conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU): a UK multicentre, open, parallel-group, randomised clinical trial

作者：Mark Peters, Doug W Gould, Samiran Ray, Karen Thomas, Irene Chang, Marzena Orzol, Lauran O’Neill, Rachel Agbeko, Carly Au, Elizabeth S. Draper, Lee Elliot-Major, Elisa Giallongo, Gareth A. Jones, Lamprini Lampro, Jon Lillie, John Pappachan, Sam Peters, Padmanabhan Ramnarayan, Zia Sadique, Kathy Rowan, David A Harrison, Paul Mouncey, Carla Thomas, P. Jirasek, Dawn Jones, Rachael Dore, Laura O'Malley, Hari Krishnan Kanthimatinathan, Helen Winmill, Lydia Ashton, Samantha Owen, Peter J. Davis, Helen Marley-Munn, Francesca Moody, Ellen Haskins, Laura Dodge, Andrew Jones, Joan Thomas, Gail Tomblin Murphy, Jon Lillie, Aleks Williams, Paul Wellman, Esther Aougah, Caroline Payne, Holly Belfield, Joshua Akpan, Sarah Benkenstein, Emily Beech, Ilham I Manjra, Sara-Louise Hulme, Avishay Sarfatti, Kirsten Beadon, Rebecca Harmer, Akash Deep, Christina Balnta, Pamela D'Silva, Asha Hylton, Bedangshu Saikia, Sanjiv Nichani, Rekha Patel, Patrick Davies, Laura Anderson, Laura Lawless, Alex Dewar, David S. Reynolds, Richard Levin, Fiona Bowman, Andrea-Rosa Pujazon, Mark Davidson, Katarzyna Szulik, Lara Bunni, Claire Jennings, Rebecca Marshall, Michael Griksaitis, Philippa Thomas, Catherine Postlethwaite, Amber Cook, Buvana Dwarakanathan, Joana Gomes De Queiroz, Montserrat Ros Foguet, Hawakiin Ali, Thomas Bycroft, Sarah Darnell, Sobia Mustafa, Katy Bridges, Kirsty Mulgrew, N. Heenan, Lynne Bell, Andrew Davies · 发表于：The Lancet · 年份：2023 · DOI：10.1016/s0140-6736(23)01968-2 · 被引用次数：77 · 研究领域：Respiratory Support and Mechanisms、Sepsis Diagnosis and Treatment、Mechanical Circulatory Support Devices

Background The optimal target for systemic oxygenation in critically ill children is unknown. Liberal oxygenation is widely practiced, but has been associated with harm in paediatric patients. We aimed to evaluate whether conservative oxygenation would reduce duration of organ support or incidence of death compared to standard care. Methods Oxy-PICU was a pragmatic, multicentre, open-label, randomised controlled trial in 15 UK paediatric intensive care units (PICUs). Children admitted as an emergency, who were older than 38 weeks corrected gestational age and younger than 16 years receiving invasive ventilation and supplemental oxygen were randomly allocated in a 1:1 ratio via a concealed, central, web-based randomisation system to conservative peripheral oxygen saturations ([SpO 2 ] 88–92%) or liberal (SpO 2 >94%) targets. The primary outcome was the duration of organ support at 30 days following random allocation, a rank-based endpoint with death either on or before day 30 as the worst outcome (a score equating to 31 days of organ support), with survivors assigned a score between 1 and 30 depending on the number of calendar days of organ support received. The primary effect estimate was the probabilistic index, a value greater than 0·5 indicating more than 50% probability that conservative oxygenation is superior to liberal oxygenation for a randomly selected patient. All participants in whom consent was available were included in the intention-to-treat analysis. The comple...