Oxygen saturation thresholds in children with acute respiratory distress (OxyKids): a multicentre, open, parallel-group, randomised clinical trial.

Summary

In this pragmatic multicenter RCT (n=566), targeting an SpO2 of 88% versus 92% in children needing oxygen for bronchiolitis, lower respiratory tract infection, or viral wheeze was safe and reduced oxygen exposure without worsening clinical outcomes.

Key Findings

• Randomized 566 children to SpO2 88% vs 92% targets across 10 hospitals in the Netherlands.
• Lower target (88%) safely reduced oxygen exposure; no signals of harm or worse clinical outcomes were observed.
• Pragmatic, multicenter design across bronchiolitis, LRTI, and viral-induced wheeze enhances generalizability within similar care settings.

Clinical Implications

Hospitals may consider adopting an SpO2 target of 88% (instead of 92%) for select pediatric acute respiratory conditions to reduce oxygen exposure and resource use without compromising safety.

Limitations

• Open-label design may introduce performance bias in oxygen weaning decisions.
• Conducted within a single national health system, which may limit global generalizability.

Future Directions

Quantify effects on hospital length of stay, readmissions, and caregiver-centered outcomes; assess applicability in resource-limited settings and with different monitoring technologies.