Oxygen saturation targets for children with respiratory distress: a systematic review
Background In children with respiratory distress, supplemental oxygen is indicated at peripheral oxygen saturation (SpO2) thresholds of 90–94%. However, these thresholds are poorly studied. We conducted a systematic review to summarise the existing evidence for SpO2 thresholds in children with respi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2023-10-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/9/5/00256-2023.full |
| _version_ | 1797629366245523456 |
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| author | Sam Louman Karlijn J. van Stralen Mariëlle W.H. Pijnenburg Gerard H. Koppelman Annemie L.M. Boehmer |
| author_facet | Sam Louman Karlijn J. van Stralen Mariëlle W.H. Pijnenburg Gerard H. Koppelman Annemie L.M. Boehmer |
| author_sort | Sam Louman |
| collection | DOAJ |
| description | Background
In children with respiratory distress, supplemental oxygen is indicated at peripheral oxygen saturation (SpO2) thresholds of 90–94%. However, these thresholds are poorly studied. We conducted a systematic review to summarise the existing evidence for SpO2 thresholds in children with respiratory distress.
Methods
Electronic databases and registries were searched for original articles published from 1 January 2010 to 7 January 2022 comparing two or more SpO2 thresholds in children with respiratory distress. Primary outcomes were safety, including mortality, neurocognitive outcomes and readmissions, and effectiveness, including admission rate and length of hospital stay. Methodological appraisal was performed using the Cochrane Risk of Bias 2 (RoB-2) or Risk of Bias in Non-Randomized Studies – of Interventions (ROBINS-I) tools. Results were narratively synthesised.
Results
We retrieved 3384 results; seven studies were included. Lower thresholds ranged from 80% to 92% and were compared with higher thresholds ranging from 92% to 94%. Studies were highly heterogeneous in setting, design, population and outcomes. Risk of bias varied from low to high. Lower SpO2 thresholds had equivalent mortality, neurocognitive outcomes and readmissions or re-attendance to healthcare to higher thresholds. Lower SpO2 thresholds showed a significant decrease in admission rates by up to 40% and shortened hospitalisation duration by 10–18 h.
Conclusions
The current SpO2 thresholds of 90–94% in children with respiratory distress may be too high, which could lead to unnecessary hospitalisations and prolonged hospitalisation duration. SpO2 thresholds as low as 88% are potentially safe in children with respiratory distress and may reduce hospitalisation rates and length of stay. However, high-quality evidence is needed to support this. |
| first_indexed | 2024-03-11T10:52:23Z |
| format | Article |
| id | doaj.art-b7b3080138f041bdb1944f3eb96ac2d0 |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-03-11T10:52:23Z |
| publishDate | 2023-10-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-b7b3080138f041bdb1944f3eb96ac2d02023-11-13T14:27:50ZengEuropean Respiratory SocietyERJ Open Research2312-05412023-10-019510.1183/23120541.00256-202300256-2023Oxygen saturation targets for children with respiratory distress: a systematic reviewSam Louman0Karlijn J. van Stralen1Mariëlle W.H. Pijnenburg2Gerard H. Koppelman3Annemie L.M. Boehmer4 Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands Department of Paediatrics/Division of Paediatric Respiratory Medicine and Allergology, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands Department of Paediatrics, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands Background In children with respiratory distress, supplemental oxygen is indicated at peripheral oxygen saturation (SpO2) thresholds of 90–94%. However, these thresholds are poorly studied. We conducted a systematic review to summarise the existing evidence for SpO2 thresholds in children with respiratory distress. Methods Electronic databases and registries were searched for original articles published from 1 January 2010 to 7 January 2022 comparing two or more SpO2 thresholds in children with respiratory distress. Primary outcomes were safety, including mortality, neurocognitive outcomes and readmissions, and effectiveness, including admission rate and length of hospital stay. Methodological appraisal was performed using the Cochrane Risk of Bias 2 (RoB-2) or Risk of Bias in Non-Randomized Studies – of Interventions (ROBINS-I) tools. Results were narratively synthesised. Results We retrieved 3384 results; seven studies were included. Lower thresholds ranged from 80% to 92% and were compared with higher thresholds ranging from 92% to 94%. Studies were highly heterogeneous in setting, design, population and outcomes. Risk of bias varied from low to high. Lower SpO2 thresholds had equivalent mortality, neurocognitive outcomes and readmissions or re-attendance to healthcare to higher thresholds. Lower SpO2 thresholds showed a significant decrease in admission rates by up to 40% and shortened hospitalisation duration by 10–18 h. Conclusions The current SpO2 thresholds of 90–94% in children with respiratory distress may be too high, which could lead to unnecessary hospitalisations and prolonged hospitalisation duration. SpO2 thresholds as low as 88% are potentially safe in children with respiratory distress and may reduce hospitalisation rates and length of stay. However, high-quality evidence is needed to support this.http://openres.ersjournals.com/content/9/5/00256-2023.full |
| spellingShingle | Sam Louman Karlijn J. van Stralen Mariëlle W.H. Pijnenburg Gerard H. Koppelman Annemie L.M. Boehmer Oxygen saturation targets for children with respiratory distress: a systematic review ERJ Open Research |
| title | Oxygen saturation targets for children with respiratory distress: a systematic review |
| title_full | Oxygen saturation targets for children with respiratory distress: a systematic review |
| title_fullStr | Oxygen saturation targets for children with respiratory distress: a systematic review |
| title_full_unstemmed | Oxygen saturation targets for children with respiratory distress: a systematic review |
| title_short | Oxygen saturation targets for children with respiratory distress: a systematic review |
| title_sort | oxygen saturation targets for children with respiratory distress a systematic review |
| url | http://openres.ersjournals.com/content/9/5/00256-2023.full |
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