Using a Quality Improvement Initiative to Decrease Oxygen Toxicity among Mechanically Ventilated Children.

Introduction:Excessive oxygen supplementation in critically ill children can lead to hyperoxia, resulting in systemic toxicity and worse outcomes. Despite evidence linking hyperoxia to adverse outcomes, the overuse of oxygen therapy remains a widespread practice. This quality improvement initiative aimed to reduce hyperoxia exposure among mechanically ventilated children in the pediatric intensive care unit at Arkansas Children's Hospital, aligning with the Second Pediatric Acute Lung Injury Consensus Conference guidelines. Methods:A multidisciplinary team implemented interventions in 2 Plan-Do-Study-Act cycles. The first cycle focused on staff education and standardizing oxygen saturation (SpO2) goals (90%-97%) in electronic health records. The second cycle introduced a best practice advisory to alert bedside staff when SpO2 exceeded 97% with the fraction of inspired oxygen (FiO2) greater than 0.21, prompting FiO2 weaning. Hyperoxia was defined as SpO2 98%-100% with FiO2 greater than 0.21. We collected hourly SpO2-FiO2 data pairs from mechanically ventilated patients and calculated hyperoxia rates monthly. Results:Baseline data (January 2021 through June 2022) showed an average hyperoxia rate of 54.8%. Following the first Plan-Do-Study-Act cycle, the rate decreased to 41.0%, and after best practice advisory implementation, it further dropped to 28%, sustaining this reduction for more than 12 months. Mortality and mechanical ventilation duration did not change significantly (11.7%-9.4%, P = 0.12; and 8.16-4.8 d, P = 0.11, respectively). Conclusions:Using quality improvement methodology and electronic health record-based clinical decision support tools, we successfully reduced hyperoxia rates among mechanically ventilated children in the pediatric intensive care unit. This initiative highlights the importance of standardized oxygen management and real-time staff reminders in improving care practices.