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Published on: October 11, 2011
Early weaning from oxygen therapy in African children with severe pneumonia
Kathryn Maitland1,2, Elisa Giallongo3, Mainga Hamaluba4
1Department Surgery and Cancer, Institute of Global Health Innovation, Imperial College London, London, UK. k.maitland@imperial.ac.uk.
Insights
Close monitoring of oxygen saturation in children with severe pneumonia led to earlier weaning and reduced oxygen use. This approach can improve access to oxygen therapy in low-resource settings.
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Global health
Background:
- Severe pneumonia is a leading cause of hospitalization and oxygen therapy needs in African children.
- Low-resource hospitals face challenges in maintaining adequate oxygen supplies.
- Current World Health Organization guidelines recommend prolonged oxygen therapy for pneumonia, with limited supporting data.
Purpose of the Study:
- To describe oxygen use and weaning timing in the COAST trial for children with severe pneumonia and hypoxemia.
- To evaluate the impact of different oxygen delivery strategies on oxygen consumption and respiratory support duration.
Main Methods:
- The COAST trial enrolled children aged 28 days to 12 years with severe pneumonia and hypoxemia (SpO2 < 92%) in Uganda and Kenya.
- Children were stratified into severe (SpO2 < 80%) and moderate (SpO2 80-91%) hypoxemia groups, receiving high flow nasal therapy (HFNT), low flow oxygen (LFO), or control.
- Oxygen weaning occurred when SpO2 exceeded 92%, with close monitoring over 48 hours.
Main Results:
- A majority of enrolled children (79%) had moderate hypoxemia.
- Early weaning was observed in both LFO and HFNT arms; by 8 hours, 55.6% in LFO and 45% in HFNT were weaned.
- At 48 hours, a significant proportion still had respiratory distress without hypoxemia, indicating successful weaning from oxygen. Median oxygen use was highest in the LFO arm.
Conclusions:
- Close SpO2 monitoring facilitates early oxygen weaning and reduces overall oxygen consumption.
- This strategy can enhance equitable access to oxygen therapy in resource-limited settings.
- Children requiring prolonged oxygen therapy beyond 48 hours were more likely to have co-existing cardiac conditions.
Background:
In Africa, severe pneumonia remains the major cause of paediatric hospitalisation, resulting in high requirements for oxygen therapy. Adequate supplies of oxygen are key challenges for many low-resource hospitals. The World Health Organization manual for oxygen therapy advises 2-3 days of oxygen therapy for pneumonia and recommends against early weaning, even in the absence of hypoxaemia. Few data support this recommendation. We describe the oxygen use and timing of weaning in the COAST trial of oxygen therapy (ISRCTN15622505).
Methods:
Children aged 28 days to 12 years presenting to 6 hospitals in Uganda and Kenya with severe pneumonia and hypoxaemia (saturations < 92% on pulse oximetry (SpO2) were eligible for the trial. Children in two strata (a) severe hypoxaemia (SpO2 < 80%) and (b) moderate hypoxaemia (SpO2 80-91%) were allocated to receive high flow nasal therapy (HFNT), low flow oxygen delivery (LFO) or control (no immediate oxygen (moderate hypoxaemia stratum only)). Children were closely monitored over 48 h by pulse oximetry and weaned off oxygen once SpO2 > 92%. We describe the oxygen use and proportion requiring respiratory support over time by intervention strategy.
Results:
Of the 1842 children enroled the majority, 1454 (79%) had moderate hypoxaemia. In this stratum, by 2 and 8 h, 148 (41%) and 200/360 (55.6%) in the LFO arm had been weaned; in the HFNT arm, 213/362 (59%) were receiving respiratory support at 2 h in room alone, and by 8 h, 164/362 (45%) had been weaned. At 48 h, in the respective strata, 77-80% and 53-63% still had respiratory distress but without hypoxaemia and were thus not receiving oxygen. Median oxygen use at 48 h in the moderate hypoxaemia group was highest in LFO am 480L (IQR 236.2, 2132.2) compared to 113.4 L (IQR 0.0, 1453.9) in the HFNT and 0 L (IQR 0.0) in the control arms. Children requiring oxygen beyond 48 h, 17/33 (51.1%) and 9/46 (19.5%) in the respective strata, had additional cardiac conditions.
Conclusions:
Closely monitoring SpO2 resulted in early weaning and reduced the use of and exposure to oxygen. Where oxygen supplies are at a premium, this approach may improve equitable access for children with severe pneumonia.
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