Oxygen saturation targets for children with respiratory distress: a systematic review

Abstract

BackgroundIn 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 forSpO2thresholds in children with respiratory distress.MethodsElectronic databases and registries were searched for original articles published from 1 January 2010 to 7 January 2022 comparing two or moreSpO2thresholds 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.ResultsWe 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. LowerSpO2thresholds had equivalent mortality, neurocognitive outcomes and readmissions or re-attendance to healthcare to higher thresholds. LowerSpO2thresholds showed a significant decrease in admission rates by up to 40% and shortened hospitalisation duration by 10–18 h.ConclusionsThe currentSpO2thresholds of 90–94% in children with respiratory distress may be too high, which could lead to unnecessary hospitalisations and prolonged hospitalisation duration.SpO2thresholds 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.