Health UK (Commonwealth Union) – A recent study conducted by researchers at the University College London (UCL) and Great Ormond Street Hospital (GOSH) reveals that lowering oxygen levels in critically ill children undergoing mechanical ventilation in intensive care has the potential to annually save dozens of young lives. The research, financially supported by the National Institute for Health and Care Research and documented in The Lancet, further indicates that decreased oxygen levels could also result in a reduction of the duration children rely on organ-supporting machines, leading to an annual cost savings of £20 million for the NHS.
The lead author, Professor Mark Peters of the UCL Great Ormond Street Institute of Child Health and Consultant Paediatric Intensivist at GOSH, says “Giving the minimum safe dose of anything in intensive care appears to generate the best outcomes, so we wanted to test this approach with oxygen. We found a small benefit of lower oxygen targets that is unlikely to have been due to chance. But because so many children are treated with oxygen, this has the potential to improve outcomes and reduce healthcare costs in the UK and around the world.
“This could have particular implications in countries where oxygen is a scare resource, or in situations as we have seen in recent years, where health needs change, and oxygen demand quickly peaks.”
In the United Kingdom, approximately 20,000 children are admitted to intensive care annually, with roughly 75% requiring supplemental oxygen through a ventilator.
Oxygen stands as a primary treatment in emergency situations, with medical professionals adjusting treatment based on the patient’s blood oxygen levels. While extremely low oxygen levels are detrimental, recent research suggests that slightly lower-than-normal levels may be optimal for very ill individuals.
Conducted by researchers from UCL, GOSH, the Intensive Care National Audit & Research Centre (ICNARC), and the Paediatric Critical Care Society Study Group (PCCS-SG), the Oxy-PICU study is the largest randomized controlled trial in pediatric intensive care units (PICUs).
The study involved 2,040 children from 15 NHS PICUs in England and Scotland, all requiring mechanical ventilation and additional oxygen upon PICU admission. Randomly assigned to two groups, they received either standard target oxygen levels (saturation “SpO2” > 94%) or reduced oxygen levels (SpO2 88-92%).
Results showed that children receiving lower oxygen levels were 6% more likely to experience positive outcomes, whether in terms of survival or the duration spent on organ-supporting machines.
Scaling this approach across the NHS could potentially save 50 lives, reduce ICU bed days by 6,000, and result in an annual cost savings of £20 million in the UK alone.
Funded by the NIHR’s Health Technology Assessment program and supported by the NIHR’s Biomedical Research Centres at GOSH and UCLH, the Oxy-PICU study is considered a significant milestone, showcasing a nurse-led research initiative that seamlessly integrated with routine clinical care. Lauran O’Neill, Senior Critical Care Nurse at GOSH, emphasized its importance as a research-hospital vision, with every child admitted to the ICU being screened for potential inclusion in the study.
Professor Marian Knight, Scientific Director for NIHR Infrastructure, highlighted the overarching goal of NIHR health and care research: to save or enhance lives by questioning existing practices or introducing new ones.
The devastating news of two-year-old Noah Karunananthan’s leukemia diagnosis in May 2022, following a visit to A&E at Hillingdon Hospital, deeply affected his family. Noah resides in Hillingdon, West London, with his mother Dilly, father Sabe, and twin sister Naima. Urgent medication necessitated sedation, prompting swift transportation to Great Ormond Street Hospital (GOSH) for treatment.
Noah spent approximately four days in the ICU, where organ support was provided during his care. During this critical period, his parents gave consent for him to participate in the Oxy-PICU trial as part of his recovery journey. Subsequently, Noah was transferred to the oncology ward for continued treatment.
