High cumulative oxygen levels are associated with improved survival of children treated with mild therapeutic hypothermia after cardiac arrest

Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

“…13,16,18,21,37 In our study, lower PaO2 values and higher oxygen needs established in terms of PaO 2 /FiO 2 rates, were found in patients with poor neurological long-term outcome, in accordance to results previously published by Vaahersalo in an adult population. 38 In contrast to their findings, carbon dioxide values were not found to influence neurologic longterm outcome in our patients, but if any, PCO 2 higher than 50 mmHg both at 1 h and 24 h after ROSC, showed a trend towards worsening neurological outcome rather than favoring it, which was observed too by Roberts et al 39 Hyperoxia was not found to be associated with a poorer neurological outcome.…”

Hyperoxia in pediatric severe traumatic brain injury (TBI): a comparison of patient classification by cutoff versus cumulative (area-under-the-curve) analysis

“…(AUC) methodology in this context has demonstrated that cumulative (AUC) analysis could lead to adequate exposure/ efficacy for the intended purpose, often at a lower dosage than initially calculated, and subsequently with less toxicity than dosing schemes based on peak and trough levels alone (13,14). Applying the same methodology to evaluate (cumulative) oxygen exposure could improve our understanding of oxygen pathophysiology in terms of safety and efficacy (12,15,17). Therefore, we found it of interest to explore this methodology in pediatric TBI, an especially vulnerable group where improved understanding of oxygen physiology may be one of the tools to improve overall outcome.…”

“…Whether the analysis of different cutoff values adequately approximates oxygen exposure is questionable due to the multifactorial and dynamic nature of oxygen physiology in combination with continuous supplemental oxygen exposure in the majority of cases. A study in pediatric post-cardiopulmonary resuscitation (CPR) patients by van Zellem et al introduced a new innovative method in defining and measuring hyperoxia and oxygen exposure: the cumulative analysis using the area-under-the-curve (AUC) PaO 2 calculation, which is a commonly used approach to estimate drug exposure in pharmacological studies (12)(13)(14). Although each method of oxygen exposure analysis has its limitations, our hypothesis is that the longitudinal, cumulative approach better addresses the (patho-)physiology of cerebral hyperoxia as it takes time-and dose-dependent factors into account (15).…”

Blowing hot or cold? Oxygenation and temperature after paediatric cardiac arrest

“…However, clinicians managing post-CA paediatric survivors remain in a quandary. Given that the conclusions in this study (12) are based on a small subset of the original study and other limitations mentioned in this editorial and the article, it is best to view this report as hypothesis generating. Presence of significant differences in PaO 2 thresholds, time periods and the heterogeneous methodology in analysis in the studies A c c e p t e d M a n u s c r i p t…”

“…Secondly, several limitations exist and are mentioned within the report. In addition to those mentioned, it is uncertain whether the use of trapezoidal rule to estimate cumulative PaO As shown in the report (12), brief periods of hyperoxia (>200 or 300 mm Hg by traditional cut-offs) may still result in relatively lower cumulative PaO 2 (Figure 3.b) whereas continuous mild hyperoxia (200> PaO 2 >100) without any period of hyperoxia (>200 or 300 mm Hg) may result in relatively higher cumulative PaO 2 (Figure 3.c). It is physiologically unlikely that all the above would have a similar effect on outcomes.…”