In this World Shared Practice Forum podcast, Dr. Mark Peters discusses the Oxy-PICU trial, published in The Lancet in January 2024, which compared conservative to liberal oxygenation targets in critically ill children. The study highlighted the importance of pragmatic trial design and the need for larger trials to confirm these findings.

LEARNING OBJECTIVES

-Discuss the background driving the investigation of oxygenation in critically ill children

-Summarize the study design of the Oxy-PICU Trial

-Present the outcomes and challenges of the Oxy-PICU Trial

-Identify the key characteristics of pragmatic trial design and the implication of pragmatic trial results

AUTHORS

Mark Peters, MBChB, MRCP, FFICM, FRCPCH, PhD

Professor of Paediatric Intensive Care

NIHR Senior Investigator

UCL Great Ormond St Institute of Child Health

Hon. Consultant Paediatric Intensivist

Paediatric Intensive Care Unit and

Children’s Acute Transport Service

Great Ormond St Hospital

Jeffrey Burns, MD, MPH

Emeritus Chief

Division of Critical Care Medicine

Department of Anesthesiology, Critical Care and Pain Medicine

Boston Children's Hospital

Professor of Anesthesia

Harvard Medical School

DATE

Initial publication date: November 26, 2024.

ARTICLES REFERENCED AND ADDITIONAL RESOURCES

Peters MJ, Gould DW, Ray S, et al. Conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU): a UK multicentre, open, parallel-group, randomised clinical trial [published correction appears in Lancet. 2024 Jan 27;403(10424):354. doi: 10.1016/S0140-6736(24)00100-4]. Lancet. 2024;403(10424):355-364. https://pubmed.ncbi.nlm.nih.gov/38048787/

Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome [published correction appears in Am J Respir Crit Care Med. 2017 Jun 1;195(11):1540. doi: 10.1164/rccm.19511erratum]. Am J Respir Crit Care Med. 2017;195(9):1253-1263. https://pubmed.ncbi.nlm.nih.gov/28459336/

Peters MJ, Ramnarayan P. Randomized Trials to Reduce Clinical Uncertainty: Gold Standard or Fool's Gold? Pediatr Crit Care Med. 2024;25(8):775-777. https://pubmed.ncbi.nlm.nih.gov/39101806/

Darnell R, Brown A, Laing E, et al. Protocol for a Randomized Controlled Trial to Evaluate a Permissive Blood Pressure Target Versus Usual Care in Critically Ill Children with Hypotension (PRESSURE). Pediatr Crit Care Med. 2024;25(7):629-637. https://pubmed.ncbi.nlm.nih.gov/38629915/

Taccone FS, Rynkowski Bittencourt C, Møller K, et al. Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. JAMA.Published online October 09, 2024. https://pubmed.ncbi.nlm.nih.gov/39382241/

Jones GAL, Eaton S, Orford M, et al. Randomization to a Liberal Versus Conservative Oxygenation Target: Redox Responses in Critically Ill Children. Pediatr Crit Care Med. 2023;24(3):e137-e146. https://pubmed.ncbi.nlm.nih.gov/36728001/

UK-ROX: https://www.icnarc.org/research-studies/uk-rox/

MegaROX: https://www.anzics.org/current-active-endorsed-research/mega-rox/

ICU-ROX: https://www.thebottomline.org.uk/summaries/icm/icu-rox/

TRANSCRIPT

https://cdn.bfldr.com/D6LGWP8S/as/rq7kgwqkh4hk4nk67584pfj/202411_-_WSP_-_Less_is_more_Oxygenation_Targets_in_Critically_Ill_Children_-_Transcript?position=2

CITATION

Peters MJ, Burns JP. Less is More: Oxygenation Targets in Critically Ill Children. 11/2024. OPENPediatrics. https://soundcloud.com/openpediatrics/less-is-more-oxygenation-targets-in-critically-ill-children-by-m-peters-openpediatrics.