(1195) Assessment of Hyperoxia Frequency in a Quaternary Care Pediatric ICU: First Step Toward Normoxia

Introduction: Studies of critically ill patients suggest that hyperoxia is associated with increased mortality and worse outcomes . Supplemental oxygen is often increased during periods of acute hypoxia, but not always decreased when a patient’s oxygen saturation (SpO2) has improved. We aimed to evaluate the current state of hyperoxia in one pediatric intensive care unit (PICU) as well as potential barriers to weaning oxygen. While goal SpO2 varies based on patients’ physiology, for this study we defined hyperoxia as SpO2 ≥98% with fraction of inspired oxygen (FiO2) >21%. We hypothesized that our patients meet this definition of hyperoxia 40% of the time.

Methods: Data was collected daily from December 2023 to May 2024 via chart review. Each hour with a documented FiO2 and SpO2 was counted, and “percent time of hyperoxia” during each patient day was calculated. Hours with FiO2>21% and SpO2≥98% while invasively mechanically ventilated or FiO2>60% and SpO2≥98% with inhaled nitric oxide (iNO) were considered hours of hyperoxia (FiO2 minimum of 60% while on iNO is unit practice). Data was recorded in REDCap with daily entries for each unique patient encounter. Additionally, surveys were sent to nursing staff to evaluate current barriers to decreasing FiO2 at the bedside.

Results: In total, 135 patient charts were reviewed. Patients met criteria for hyperoxia for a median of 26.9% (IQR 19.6-32.7%) of each 24-hour period. Order review showed 77% did not have an order for an upper limit for goal SpO2, 55% did not have any order for goal SpO2, and only 12% had a clear and specific order in place. Nurses reported common barriers to weaning FiO2 included lability of patients’ SpO2, lack of knowledge of SpO2 goals, unclear responsibility, lack of reminders, and lack of culture to aggressively wean.

Conclusions: This study demonstrates the current state of hyperoxia in one quaternary care PICU and barriers to weaning FiO2 at the bedside. Patients frequently had higher FiO2 than needed to achieve normoxia. Next steps will be to design a quality improvement initiative to guide nurses, providers, and therapists in weaning FiO2. Based on unit data, an order with upper and lower SpO2 limits will be designed to encourage efficient and safe weaning of FiO2.