The response of children aged 2-59 months with pneumonia to oxygen therapy using routine oxygen delivery methods at Kenyatta National Hospital

Abstract

Hypoxaemia is a common and potentially lethal complication of acute lower respiratory tract infections .The outcome of children with hypoxaemia correlates with the severity ofhypoxaemia and mortality is reduced with oxygen therapy. To evaluate clinical response and change in oxygen saturation to oxygen therapy in children aged 2- 59 months with hypoxaemia caused by very severe or severe pneumonia admitted at KNH. Descriptive cross sectional survey. Paediatric Emergency Unit and Paediatrics general wards at KNH Children aged between 2 and 59 months admitted with very severe or severe pneumonia who had hypoxia on the initial assessment. The principle investigator and a research assistant daily recruited the first three eligible patients. Patient's social-demographic data, clinical history, physical examination and oxygen saturation were recorded in the questionnaire. Patients were followed up on the wards, where oxygen saturation, flow rate, mode of delivery and focused clinical signs were evaluated at lhr, 3hr and 6hr after initiating oxygen therapy. One hundred and one children were enrolled. The ratio of male and female was equal. The mean age was nine months. Two thirds had very severe pneumonia while rest had severe pneumonia. At base line the median oxygen saturation in children with very severe pneumonia was 78%, whereas the median oxygen saturation for those with severe pneumonia was 85.5%. There was normalization of oxygen saturation (Sp02 2: 90%) of all children in the study population after 1, 3 and 6 hour of oxygen therapy, despite of the different oxygen delivery methods used. Grunting, head nodding, nasal flaring and inability to feed improved significantly after 6 hour of oxygen therapy. However, lower chest in drawing did not improve after six hours of oxygen therapy.

The nasal catheter, oxygen mask with reservoir, nasal prong and nasal catheter via intravenous giving set "octopus", all appeared effective in improving oxygenation in children with pneumonia. Low flow rate administration of oxygen by nasal catheter is an effective method to improve oxygenation even in children with very severe pneumonia and oxygen saturation < 75%. Delivery oxygen via "Octopus" appears effective, however individually regulated administration would be preferred. Further studies are required to study the oxygen flow rate regulation and patient's safety using the "Octopus"