Related Experiment Video
Updated: Dec 27, 2025
Conducting Respiratory Oscillometry in an Outpatient Setting
Published on: April 8, 2022
Oximetry-detected pulsus paradoxus predicts for severity in paediatric asthma
Sandhya G Krishnan1, Hung Chew Wong2, Sashikumar Ganapathy3
1Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore sandhya.gkrishnan@mohh.com.sg.
Insights
Pulsus paradoxus (PP) detected visually on pulse oximetry can predict poor outcomes in children with severe respiratory distress. This simple bedside tool aids in assessing treatment response for pediatric asthma exacerbations.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Physiology
- Critical Care
Background:
- Moderate to severe respiratory distress in children poses significant management challenges.
- Accurate and timely assessment of treatment response is crucial for pediatric patients.
Purpose of the Study:
- To evaluate if visual detection of pulsus paradoxus (PP) on pulse oximeter plethysmography can predict outcomes in children with moderate to severe respiratory distress.
- To assess the utility of PP as a point-of-care tool in the pediatric emergency department (ED).
Main Methods:
- Prospective cohort study conducted in a pediatric ED.
- 285 children with moderate to severe wheezing were assessed for PP before and after initial bronchodilator therapy.
- Outcomes included need for adjunct medications, supplementary ventilation, and ICU/HDU admission.
Main Results:
- Pulsus paradoxus (PP) was present in 27.4% at presentation and 14.0% after initial management.
- Children with PP after treatment had significantly higher risks of requiring adjunct medications (RR 12.5), supplementary ventilation (RR 5.6), and ICU/HDU admission (RR 5.6).
Conclusions:
- Qualitative visual detection of PP on pulse oximetry is a potential point-of-care tool for assessing treatment response in pediatric asthma exacerbations.
- Further studies are needed to validate its role in guiding ED management of acute pediatric asthma.
Objective:
To evaluate if qualitative visual detection of pulsus paradoxus (PP) on the pulse oximeter plethysmograph can predict outcomes for children with moderate to severe respiratory distress in a paediatric emergency department (ED).
Design:
Prospective cohort study.
Setting:
Paediatric ED of a tertiary paediatrics hospital in Singapore.
Patients:
Children managed for moderate to severe wheezing in the resuscitation bay of the ED.
Interventions:
Patients were assessed for the presence of PP based on visual detection of oximeter plethysmograph before and after initial inhaled bronchodilator therapy.
Main Outcome Measures:
These include the need for adjunct medications such as aminophylline or magnesium sulfate, the need for supplementary ventilation and the need for admission to the high dependency unit (HDU) or intensive care unit (ICU).
Results:
There were 285 patients included in the study, of whom 78 (27.4%) had PP at ED presentation. There were 40 (14.0%) who had PP after initial management. Children who had PP after initial management had significantly relative risks (RR) of requiring adjunct medications (RR 12.5, 95% CI 4.0 to 38.6), need for supplementary ventilation (RR 5.6, 95% CI 1.2 to 26.5) and admission to the HDU/ICU (RR 5.6, 95% CI 3.0 to 10.4).
Conclusion:
Qualitative detection of PP on pulse oximetry can be used as a potential point-of-care tool to help in the assessment of response to initial treatment in paediatric patients with acute moderate to severe asthma exacerbations. Future studies are needed to assess and validate its role in guiding ED management of acute paediatric asthma.
Related Concept Videos
01:17Measurement of Blood Pressure
01:24Pulse Oximetry
Purpose
Average SpO2 values are greater than 95%. If the readings fall below 90%, it indicates that...
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:19Special considerations while measuring oxygen saturation
Ensuring accuracy in vital sign recordings while prioritizing patient comfort and minimizing anxiety is...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:16Pulse
The pulse serves as a clinical...