Conservative Versus Liberal Oxygenation Targets in Critically Ill Children (Oxy-PICU)

A Randomised Pilot Multiple Centre Trial of Conservative Versus Liberal Oxygenation Targets in Critically Ill Children

A feasibility study to determine if it is possible to perform a safe, adequately powered, and affordable multi-centre study in critically ill children comparing current practice of liberal targets for systemic oxygen levels with more conservative targets.

Study Overview

• Status: Completed
• Conditions: Hypoxia; Pediatric ALL; Critical Care
• Intervention / Treatment: Procedure: Conservative oxygenation target; Procedure: Liberal oxygenation target

Detailed Description

Around 19,000 critically ill children are admitted to paediatric intensive care units (PICU) each year in the UK. A large number of these children need breathing support, and this is usually provided through an invasive machine called a 'ventilator'. Clinicians make decisions for treatment based on how much oxygen their patient has in their blood (this is called oxygen saturation or oxygenation) and currently the amount of oxygen critically ill children need is not fully understood. This means that some clinicians use a lower oxygen saturation target, and others, a higher target. This may be problematic as research in neonates (babies) and adults has shown that oxygen saturation levels can influence a patient's chance of survival, how long they stay in hospital and healthcare costs.

Response to oxygen is different in babies, children and adults. This means that the results from the neonatal and adult research are unlikely to be valid or applicable in children due to age-related differences. Urgent high quality clinical evidence is therefore needed to inform on the best targets of oxygenation during critical illness in children.

As large clinical trials are expensive to conduct, it is important to demonstrate that a large-scale trial can be done and that the different components of a trial can all work together. Therefore, the Oxy-PICU study is a 'pilot randomised clinical trial' (a smaller version of the trial we would like to conduct) and will test the feasibility and safety of conducting a large scale trial comparing a restrictive oxygen saturation target (88-92%) with a more liberal oxygen saturation target (>94%). Oxy-PICU will also collect blood and urine samples to allow for in depth study of the biology of the different oxygenation targets.

The pilot trial will take place at three PICUs (two in London and one in Southampton) and aims to include between 115-125 eligible children over six months. Given the emergency nature of these children and the need to provide immediate care, informed consent will be sought after the children are entered into the study (this is known as deferred consent).

• Study Type: Interventional
• Enrollment (Actual): 120
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom
    • St Mary's Hospital
  • London, United Kingdom
    • Great Ormond Street Hospital for Children
  • Southampton, United Kingdom
    • Southampton General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 8 months to 15 years (CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• less than 16 years and > 38 weeks corrected gestational age
• receiving supplemental oxygen for abnormal gas exchange
• emergency admission accepted to a participating paediatric intensive care unit (PICU) requiring mechanical ventilation within first 6 hours of face-to-face contact with PICU staff or transport team

Exclusion Criteria:

• recruited to Oxy-PICU in a previous admission
• brain pathology/injury as a primary reason for admission (e.g traumatic brain injury, post-cardiac arrest, stroke, convulsive status epilepticus without aspiration)
• known pulmonary hypertension
• known or suspected sickle cell disease
• known or suspected uncorrected congenital cardiac disease
• End-of-life care plan in place with limitation of resuscitation
• not expected to survive PICU admission
• receiving long-term mechanical ventilation prior to this admission (non-invasive ventilation or invasive ventilation)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Conservative oxygenation target; Children in the conservative oxygenation target group receive treatment targeting oxygen saturation values of 88-92%.	Procedure: Conservative oxygenation target; Participants allocated to the conservative oxygenation target group will receive supplemental oxygen and ventilator settings at the discretion of the treating clinical team with the aim of peripheral oxygen saturations remaining 88-92% (inclusive).
ACTIVE_COMPARATOR: Liberal oxygenation target; Children in the liberal oxygenation target group receive treatment targeting oxygen saturation values of >94%.	Procedure: Liberal oxygenation target; Participants allocated to the liberal oxygenation target group will receive supplemental oxygen and ventilator settings at the discretion of the treating clinical team with the aim of peripheral oxygen saturations remaining >94%.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of eligible patients recruited per site per month	Baseline

Secondary Outcome Measures

Outcome Measure	Time Frame
Proportion of parents/legal representatives refusing deferred consent	Through study completion, an average of 24 hours
Proportion of eligible patients randomised	Baseline
Distribution of time to randomisation	Baseline
Proportion of systemic oxygen saturations within the target range in each group	Through study completion, an average of 72 hours
Proportion of patients in each arm requiring other treatments influencing tissue oxygen delivery (blood transfusion, inotropic support)	Through study completion, an average of 72 hours
Length of ventilation - proportion of randomised patients with outcome available in each group	Through study completion, an average of 2 days
Length of ventilation - mean (standard deviation) in each group	Through study completion, an average of 2 days
Length of ventilation - median and quartiles in each group.	Through study completion, an average of 2 days
Observed adverse events	28 days
Time taken for data collection and entry	28 days
Measurement of ischemia-modified albumin (plasma)	72 hours
Measurement of malondialdehyde (plasma)	72 hours
Measurement of total antioxidant status (plasma)	72 hours
Length of PICU stay - proportion of randomised patients with outcome available in each group	Through study completion, an average of 2 days
Length of PICU stay - mean (standard deviation) in each group.	Through study completion, an average of 2 days
Length of PICU stay - median and quartiles in each group.	Through study completion, an average of 2 days
Hospital mortality - proportion of randomised patients with outcome available in each group	Through study completion, an average of 2 days
Hospital mortality - number (percentage) in each group.	Through study completion, an average of 2 days
PICU mortality - proportion of randomised patients with outcome available in each group	Through study completion, an average of 2 days
PICU mortality - number (percentage) in each group.	Through study completion, an average of 2 days
Days of organ specific support - proportion of randomised patients with outcome available in each group	Through study completion, an average of 2 days
Days of organ specific support - mean (standard deviation) in each group	Through study completion, an average of 2 days
Days of organ specific support - median and quartiles in each group	Through study completion, an average of 2 days
Measurement of hypoxia-inducible factor-1 alpha mRNA expression (leukocytes)	72 hours

Collaborators and Investigators

• Sponsor: Great Ormond Street Hospital for Children NHS Foundation Trust
• Collaborators: University College, London; University of Southampton; University Hospital Southampton NHS Foundation Trust; St Mary's Hospital, London; Intensive Care National Audit & Research Centre

Publications and helpful links

General Publications

• Peters MJ, Jones GAL, Wiley D, Wulff J, Ramnarayan P, Ray S, Inwald D, Grocott M, Griksaitis M, Pappachan J, O'Neill L, Eaton S, Mouncey PR, Harrison DA, Rowan KM; Oxy-PICU Investigators for the Paediatric Intensive Care Society Study Group (PICS-SG). Conservative versus liberal oxygenation targets in critically ill children: the randomised multiple-centre pilot Oxy-PICU trial. Intensive Care Med. 2018 Aug;44(8):1240-1248. doi: 10.1007/s00134-018-5232-7. Epub 2018 Jun 4.
• Jones GAL, Ramnarayan P, Raman S, Inwald D, Grocott MPW, Eaton S, Ray S, Griksaitis MJ, Pappachan J, Wiley D, Mouncey PR, Wulff J, Harrison DA, Rowan KM, Peters MJ; Oxy-PICU Investigators for thePaediatric Intensive Care Society-Study Group (PICS-SG). Protocol for a randomised pilot multiple centre trial of conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU). BMJ Open. 2017 Dec 14;7(12):e019253. doi: 10.1136/bmjopen-2017-019253.

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 4, 2017
• Primary Completion (ACTUAL): June 25, 2017
• Study Completion (ACTUAL): July 1, 2017

Study Registration Dates

• First Submitted: November 21, 2016
• First Submitted That Met QC Criteria: January 31, 2017
• First Posted (ESTIMATE): February 2, 2017

Study Record Updates

• Last Update Posted (ACTUAL): February 23, 2018
• Last Update Submitted That Met QC Criteria: February 22, 2018
• Last Verified: February 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Signs and Symptoms, Respiratory; Hypoxia
• Other Study ID Numbers: 15IA35

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No