Severity of Impaired Oxygenation and Conservative Oxygenation Targets in Mechanically Ventilated Children: A Post Hoc Subgroup Analysis of the Oxy-PICU Trial of Conservative Oxygenation.

Summary

In a post hoc subgroup analysis of the Oxy-PICU RCT (n=1,775), conservative oxygenation (SpO2 88–92%) benefited mechanically ventilated children irrespective of severe oxygenation impairment (OSI≥12). No significant interaction by OSI category was detected, supporting broad application of conservative targets.

Key Findings

• Data from 1,775 of 1,986 eligible children were analyzed; 212 had OSI ≥ 12 at randomization.
• The composite primary outcome did not differ significantly by OSI category; conservative oxygenation benefited both OSI < 12 (OR 0.85, 95% CI 0.71–1.01) and OSI ≥ 12 (OR 0.95, 95% CI 0.49–1.84).
• Findings do not support limiting conservative oxygenation targets to children with severely impaired oxygenation.

Clinical Implications

PICUs can implement SpO2 88–92% targets in ventilated children across oxygenation severities, with ongoing monitoring for safety; future prospective stratified trials can refine thresholds.

Limitations

• Post hoc subgroup analysis of an open-label trial; not pre-specified
• Findings are associative within subgroups and require prospective confirmation

Future Directions

Prospective stratified trials to confirm conservative oxygenation benefits across severity strata and to assess safety endpoints (e.g., ischemic events, neurodevelopment) under lower SpO2 targets.