ABSTRACT
Hypoxaemia is a common complication of acute lower respiratory tract infections in children. In most developing countries, where the majority of deaths from pneumonia occur, facilities for early detection of hypoxaemia are lacking and oxygen is in short supply. This review examines the usefulness of different clinical signs and symptoms in the prediction of hypoxaemia associated with acute respiratory infections in children. Several respiratory signs were found to be associated with hypoxaemia. These include very fast breathing (with a respiratory rate of more than 60 or 70 breaths per minute), cyanosis, grunting, nasal flaring, chest retractions, head nodding and auscultatory signs, as well as signs of general depression of the child, such as inability to feed or lethargy. The sensitivity and specificity of these signs, as described in the reviewed studies, is presented, and combination rules are discussed. Through appropriate combination of several physical signs, which can be used by peripheral health workers and be taught to mothers, it is possible to predict hypoxaemia in children with acute respiratory tract infections with reasonable accuracy.
Subject(s)
Hypoxia/diagnosis , Hypoxia/etiology , Oxygen Inhalation Therapy , Respiratory Tract Infections/complications , Respiratory Tract Infections/diagnosis , Acute Disease , Child, Preschool , Humans , Hypoxia/therapy , Infant , Infant, Newborn , Prognosis , Respiratory Tract Infections/therapy , Sensitivity and SpecificityABSTRACT
Oxygen administration is one of the most important modalities of therapy for a patient with hypoxaemia to prevent death. This review summarises the methods of oxygen delivery applicable in small hospitals in developing countries, and evaluates information about their safety and efficacy. The following criteria were considered: cost and availability, efficiency/oxygen concentration achieved, tolerability/comfort of the method, requirement of humidification, demand for nursing care, and safety of the method and complications. In summary, it is concluded that all low-flow methods, i.e., nasopharyngeal catheters, nasal catheters and prongs, are effective in the oxygenation of sick children with severe pneumonia or bronchiolitis. Nasal prongs are the safest method of oxygen delivery, but nasopharyngeal catheters and nasal catheters are more easily available and less expensive. However, if they are used, they need close supervision to avoid serious complications. Nasal prongs are the method of choice for oxygen delivery in small hospitals in developing countries.
