Conservative Oxygen Strategies in Pediatric Critical Care: A Narrative Review to Inform Patient Selection and Oxygen Management

This narrative review relates evidence on conservative oxygen strategies to pediatric intensive care populations and decisions about oxygen titration or discontinuation, aiming to reduce unnecessary and potentially harmful exposure. Studies were identified through PubMed, Embase, and Cochrane Central Register of Controlled Trials searches and reference-list checking. In selected invasively ventilated children, a multicenter randomized trial found that conservative targets (peripheral oxygen saturation 88–92%) reduced oxygen administration and yielded a small favorable shift in the primary composite outcome of organ-support duration or death, without establishing a definitive mortality benefit. In selected ward populations, a 90% threshold reduced oxygen use and time to discharge in bronchiolitis, while an 88% threshold reduced oxygen use and hospital stay in respiratory illness. Neither ward trial showed increased short-term harm in assessed outcomes. Application to pediatric intensive care patients requires evaluation of trial eligibility and disease-specific physiology. Quality-improvement priorities include target selection, oxygen reassessment, separating oxygen discontinuation from respiratory support, and evaluating safety and equity, including pigmentation-associated oximetry error. Research priorities include noninvasive-support targets, criteria for oxygen reduction and discontinuation, and whether automated titration reduces exposure or improves clinical outcomes.