Background: Oxygen therapy is an essential component of pediatric intensive care; however, liberal administration may contribute to oxidative stress, alveolar injury, and adverse clinical outcomes. Evidence from adult and limited pediatric studies suggests that supraphysiological oxygen exposure may increase mortality and prolong recovery, yet prospective data in mechanically ventilated children remain scarce, particularly from low- and middle-income countries. Objectives: To determine the association between cumulative fraction of inspired oxygen (FiO₂) exposure and mortality among mechanically ventilated children aged one month to five years and to evaluate its relationship with the duration of hospital stay. Methods: A prospective observational study was conducted in the Pediatric Intensive Care Unit (PICU) of a tertiary hospital in Bhopal, India, from June 2024 to December 2025. Consecutive children aged one month to five years requiring invasive ventilation for more than 24 hours were enrolled. Cumulative FiO₂ exposure (sum of hours at each FiO₂ level × duration) was calculated from ventilator logs. Demographic, nutritional, and clinical parameters were recorded using a pre-tested proforma. Outcomes were classified as survived or death. Statistical analyses were performed using Stata v14.2; logistic regression identified mortality predictors, and Spearman's correlation assessed the association between FiO₂ exposure and length of hospital stay. Results: A total of 140 children were included (median (IQR) age 16 (8-36) months; 49.3% male). The median cumulative FiO₂ exposure was 72 (48-84) hours. Mortality was 6.4% (n = 9), and the survival rate was 93.6% (n = 131), comprising 81.4% discharged and 12.1% left against medical advice (LAMA). On multivariable logistic regression, cumulative FiO₂ exposure independently predicted mortality (aOR: 1.22; 95% CI: 1.02-1.46; p = 0.027) after adjustment for age, sex, nutritional status, system involvement, sepsis, and ventilation duration. Male sex (aOR: 2.38; 95% CI: 1.02-5.56; p = 0.046) was also a significant predictor. A strong positive correlation existed between cumulative FiO₂ exposure and length of hospital stay (Spearman r = 0.74; p < 0.001), indicating dose-dependent prolongation of hospitalization. Conclusion: In this prospective cohort from a tertiary PICU in central India, higher cumulative FiO₂ exposure independently predicted mortality and longer hospital stay. These findings highlight the urgent need for rational oxygen titration and structured pediatric oxygen stewardship to reduce hyperoxia-related harm.
Rani et al. (Wed,) studied this question.