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 (S_pO2) thresholds of 90–94%. However, these thresholds are poorly studied. We conducted a systematic review to summarise the existing evidence for S_pO2 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 S_pO2 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 S_pO2 thresholds had equivalent mortality, neurocognitive outcomes and readmissions or re-attendance to healthcare to higher thresholds. Lower S_pO2 thresholds showed a significant decrease in admission rates by up to 40% and shortened hospitalisation duration by 10–18 h. 

Conclusions:

The current S_pO2 thresholds of 90–94% in children with respiratory distress may be too high, which could lead to unnecessary hospitalisations and prolonged hospitalisation duration. S_pO2 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.