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Journal update
Journal update monthly top five
  1. Gabrielle Prager1,
  2. Robert Hirst2,
  3. Daniel Darbyshire3,
  4. Patricia Van Den Berg4,
  5. Govind Oliver5,6,
  6. Thomas Alexander Gerrard Shanahan7,
  7. Simon David Carley8,9
  1. 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2 Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  3. 3 Lancaster Medical School, Lancaster University, Lancaster, UK
  4. 4 Emergency Department, Stockport NHS Foundation Trust, Stockport, UK
  5. 5 Wythenshawe Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
  6. 6 Grounded Research Team, Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, UK
  7. 7 Emergency Department, Royal Blackburn Teaching Hospital, Blackburn, UK
  8. 8 Postgraduate Medicine, Manchester Metropolitan University, Manchester, UK
  9. 9 Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Gabrielle Prager, Department International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; lgprager{at}doctors.org.uk

https://doi.org/10.1136/emermed-2024-213942

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    This month’s update is by the EMJ journal update monthly top five core team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

    The papers are ranked as:

    • Worth a peek—interesting, but not yet ready for prime time.

    • Head turner—new concepts.

    • Game changer—this paper could/should change practice.

    Conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU): a UK multicentre, open, parallel-group, randomised clinical trial by Peters et al

    Topic: paediatrics

    Outcome rating: head turner

    Hyperoxia and oxygen toxicity can cause harm in critically unwell children. Given this concern, there is a need to determine if lower oxygen saturation (SpO2) targets are safe. Recent work in adults has demonstrated no harm from the use of lower SpO2 targets.1 2

    The Oxy-PICU Study was a pragmatic, multicentre, open-label randomised controlled trial in 15 paediatric intensive care units (PICUs). Children >38 weeks’ corrected gestational age and <16 years admitted as an emergency receiving invasive ventilation were randomised to conservative (88–92%) or liberal (>94%) SpO2 targets. Notable exclusion criteria were brain injury and congenital heart disease.

    The primary outcome was rank-based duration of organ support at 30 days following allocation, with death the worst outcome and survivors receiving a score between 1 and 30 based on days of organ support. Secondary outcomes were 30-day mortality, time free from invasive ventilation, adverse events, functional status, hospital/PICU length of stay and cost.

    2040 children were randomised equally to the two groups. Death and organ support duration during the first 30 days was significantly lower in the conservative group (median 5 (IQR 3–9) days) than in the liberal group (median …

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    Footnotes

    • Twitter @hirstposition, @clifford0584

    • Contributors All authors contributed to the searching, writing and editing of this article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.