Prevalence of hypoxaemia and its associated factors in children with pneumonia seen at a tertiary hospital in Southeast Nigeria

Background: Hypoxaemia is a common complication and a significant predictor of death from pneumonia in children under five years of age. Knowledge of the prevalence of hypoxaemia and clinical signs associated with it may guide use of oxygen in the management of childhood pneumonia in resource-poor settings. This study was carried out to determine the prevalence of hypoxaemia in children with pneumonia and assess the relation between hypoxaemia and age, duration of illness and clinical signs.Methods: This was a descriptive cross-sectional study undertaken between 1st July 2016 and 27th April 2017. Children with pneumonia, aged 2-59 months, who attended Federal Medical Centre, Owerri and met the inclusion criteria, were recruited into the study. Subject evaluation included history and physical examination. Their blood oxygen saturation was determined by pulse oximetry and value less than 90% indicated hypoxaemia.Results: Out of the 144 children with pneumonia, 93(64.6%) were males and 51(35.4%) females giving a male to female ratio of 1.8:1. Median age was 8 months and mean weight (SD) was 8.6 kg (3.6). The overall prevalence of hypoxaemia was 17.4%. Hypoxaemia prevalence was significantly higher in infants (p=0.026) and severe pneumonia (p<0.0001). There was statistically significant association between hypoxaemia and lower chest in-drawing, nasal flaring, suprasternal recession, grunting, lethargy, tachypnoea and tachycardia. With adjustment for confounding variables, only lower chest in-drawing (OR: 9.672; p=0.004), lethargy (OR: 8.103; p=0.020) and grunting (OR: 4.960; p=0.050) predicted hypoxaemia in pneumonia. Each of these signs had a poor combination of sensitivity and specificity.Conclusions: Hypoxaemia is common in childhood pneumonia. Though some clinical signs are significantly associated with hypoxaemia in childhood pneumonia, they may be unreliable in predicting hypoxaemia. Therefore, pulse oximeters should be provided in every health facility for accurate detection of hypoxaemia.

Interstitial Lung Disease and Profound Hypoxaemia in a Severely-malnourished Child with Very Severe Pneumonia and Potential Lymph-node Tuberculosis: An Uncommon but Serious Co-morbidity.

A nine-month old boy was initially admitted at the Acute Respiratory Infection Unit of Dhaka Hospital of icddr,b and soon after transferred to the Intensive Care Unit of the same hospital. The boy had problems of very severe pneumonia (confirmed by radiology), severe hypoxaemia, severe malnutrition, and Down’s syndrome. The patient was treated according to the hospital protocol for the management of pneumonia and malnutrition. During the hospital stay, hypoxaemia was persistent with very little improvement of pneumonia; a number of differentials, such as pneumocystis jirovecii pneumonia, lymph-node tuberculosis, were added to the problems. Subsequently, the patient’s hypoxaemia improved with the empirical use of antitubercular drugs. However, the patient again developed persistent hypoxaemia and, after unsuccessful treatment for a hospital-acquired pneumonia, the problems further expanded to include interstitial lung disease (ILD). This was confirmed by high-resolution computed tomography, and the patient was treated with prednisolone for 6 months, along with antitubercular drugs. He fully recovered from ILD, hypoxaemia, and pneumonia both clinically and radiologically. Therefore, severely-malnourished children having wet cough and pneumonia with persistent hypoxaemia should be assessed for the possible existence of interstitial lung disease. This may help provide a prompt and appropriate management to reduce morbidity and deaths in such patients.

Fisioterapia respiratória em neonatologia: importância e cuidados / Chest physiotherapy in neonatology: importance and management

Objetivo: Avaliar a importância da fisioterapia respiratória nos cuidados intensivos neonatais, por meio dos trabalhos já publicados na literatura. Métodos: Fontes de dados pesquisadas: Medline, Cochrane Library, LILACS, SciELO. As palavras-chave utilizadas foram neonatos, fisioterapia respiratória, remoção de secreções, hipoxemia e bradicardia. Resultados: A atuação da fisioterapia respiratória foi avaliada entre os cuidados intensivos neonatais, bem como os efeitos da aplicação de suas técnicas. Tem sido aceito que a fisioterapia ajuda na prevenção de complicações respiratórias (diminuição da ventilação e/ou perfusão, obstrução das vias aéreas e aumento do trabalho respiratório) porém, devido à existência de trabalhos com diferentes metodologias e realizados em décadas diferentes, torna-se difícil fazer uma comparação dos seus resultados e, dessa forma, apresentar evidências sobre os efeitos da aplicação das técnicas fisioterapêuticas. Conclusões: A fisioterapia respiratória parece ter um papel importante nos cuidados intensivos neonatais, mas devido à escassez de trabalhos na área se torna difícil a comprovação de seus benefícios.

Peritoneal Ventilation with Pure Oxygen Improves Hypoxaemia of Rabbits Induced By Mechanical Controlled Hypoventilation / 中国呼吸与危重监护杂志

Objective To observe the effects of peritoneal ventilation with pure oxygen in the rabbits with hypoxaemia and hypercapnia induced by mechanical controlled hypoventilation.Methods Sixteen rabbits were invasive|y ventilated after trachea incision.Hypoxaemia and hypercapnia were induced by hypoventilation which was implemented both by degrading ventilation parameters and respiratory depression induced by intravenous infusion of muscle relaxant.Then pure oxygen was insufflated into the peritoneal cavity and arterial blood gases were measured every 30 minutes for two hours.Results The PaO2 was (52.50±3.46)mm Hg at baseline and increased to (76.46±7.79) mm Hg, (79.62±9.53) mm Hg, (78.54±7.18) mm Hg, and (81.1±8.3) mm Hg, respectively at 30,60,90, and 120 minutes after the peritoneal ventilation with pure oxgen (all P < 0.05).Meanwhile PaCO2 was (63.84±9.09)mm Hg at baseline and (59.84±14.22) mm Hg, (59.16±15.5) mm Hg, (60.02±7.07) mm Hg, and (61.38± 6.56)mm Hg, respectively at 30,60,90, and 120 minutes after the peritoneal ventilation with pure oxgen with no significant change (P > 0.05).Conclusion Peritoneal ventilation can obviously improve hypoxaemia induced by mechanical controlled hypoventilation, whereas hypercapnia remains unchanged.

The role of general practitioners in home oxygen therapy

Recommendation of oxygen therapy must include clear indication and benefits of its use, appropriate prescription, vigilant monitoring and appropriate methods of delivery. Home oxygen therapy is expensive, inconvenient and cumbersome; it should be recommended only if benefits outweigh the disadvantages and adverse effects of oxygen. GPs play an important supportive and supervisory role in the use of long-term oxygen therapy (LTOT) to improve mortality of patients with chronic hypoxaemia. Prescription of short burst oxygen therapy (SBOT) for palliation of breathlessness is without clear evidence of its efficacy. GPs can prescribe SBOT when other secondary causes of breathlessness are excluded or treated, when breathlessness is not relieved by other treatments and if an improvement can be documented in patients.