What hyperoxia means for critically ill children

Supplemental oxygen is a major element of critical care, but is there such a thing as too much of good thing? A meta-analysis examines the impact of hyperoxia on mortality in critically ill children.

The use of supplemental oxygen is a key component when providing critical care in the hospital. Evidence has shown that overusing it can lead to hyperoxia, which may lead to worse outcomes than those with a normal oxygen level. A meta-analysis examined whether this was true in the pediatric population.1

Investigators performed a systematic research of EMBASE, MEDLINE, Cochrane Library, and ClinicalTrials.gov. There were no language restrictions applied to the search. They included clinical trials or observational studies of children who were admitted to a pediatric intensive care unit that examined for hyperoxia and included at least 1 outcome of interest. Primary outcome was 28-day mortality and secondary outcomes included ventilator-related outcomes, extracorporeal organ support, functional performance, and length of stay.

A total of 16 studies, which involved 27,555 patient, were included in the meta-analysis. Fifteen were observational cohort studies and 1 was a randomized clinical pilot trial. The study populations included post–cardiac arrest (n = 6), traumatic brain injury (n = 1), extracorporeal membrane oxygenation (n = 2), and general critical care (n = 7). Both the definition and assessment used for hyperoxia was different among the included studies. The most frequently used measure to define hyperoxia was partial pressure of arterial oxygen, which was determined mainly by categorical cutoff. By any definition, hyperoxia had an odds ratio for mortality of 1.59 (95% CI, 1.00-2.51; after Hartung-Knapp adjustment, 95% CI, 1.05-2.38). Signal of harm was seen at higher thresholds of arterial oxygen levels when clustered using the definition of hyperoxia. There were inadequate data to include the secondary outcomes in the meta-analysis.

The investigators determined that the results indicate the hyperoxia is linked to mortality in critically ill children, even with the methodological limitations they noted for the included studies. They urged for further prospective observational studies to better study the connection as well as the need to address the implications of hyperoxia in children who are critically ill.


1. Lilien T, Groeneveld N, van Etten-Jamaludin F, et al. Association of arterial hyperoxia with outcomes in critically ill children: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(1):e2142105. doi:10.1001/jamanetworkopen.2021.42105