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Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of ageRojas-Reyes MX, Granados Rugeles C, Charry-Anzola LP
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SummaryOxygen therapy is used as a complementary therapy in the treatment of lower respiratory tract infections in childrenThe main objectives of this review were to determine the effectiveness and safety of non-invasive oxygen delivery systems in children's recovery from lower respiratory tract infections (LRTIs). Other objectives were to determine the indications for oxygen therapy, describe the clinical criteria for ending oxygen therapy, determine the indications for continuing oxygen therapy after discharge, and estimate costs associated with each method of oxygen delivery. To answer these questions we conducted a wide search for randomised controlled trails (RCTs) of oxygen therapy in the treatment of LRTI in children. We did not find any trials comparing oxygen versus no oxygen. Only four RCTs and one systematic review met all the criteria for eligibility. The evidence found suggests that nasal prongs may be more effective than nasopharyngeal and nasal catheters for delivering oxygen to paediatric patients with LRTI, particularly because nasal prongs have few secondary effects and no severe adverse events. However, the 95% confidence intervals (CI) obtained in the overall analysis of risk of treatment failure and risk of adverse events, showed a lack of precision in both cases. There is not enough evidence to determine which of the non-invasive delivery methods available should be used in the treatment of hypoxaemia in children with LRTI. We found no clinical signs, model or score system that accurately identifies hypoxaemic children. Since resources differ among settings, efficacy, patient tolerability, patient safety, cost and availability have to be considered when choosing the best non-invasive oxygen delivery method in the treatment of children with hypoxaemic LRTI. To aid health workers make the best decisions, studies aimed at identifying the most effective and safe non-invasive oxygen delivery method are required. Further research must consider the efficacy, tolerability, safety and costs of the methods studied .
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 21. 2009 AbstractBackgroundUsual practice in lower respiratory tract infections (LRTIs) includes administering complementary oxygen. The effectiveness of oxygen therapy and different methods of delivery is unknown. This review contributes to the rational use of oxygen in the treatment of LRTIs. ObjectivesTo determine in the treatment of LRTIs: Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2); MEDLINE (January 1966 to March 2008); EMBASE (1990 to December 2007); and LILACS (January 1982 to March 2008). Selection criteriaRandomised controlled trials (RCTs) comparing oxygen versus no oxygen therapy or methods of oxygen delivery for hypoxaemic LRTIs in children (3 months to 15 years of age). To determine indications for oxygen therapy, observational studies were included. Data collection and analysisWe assessed 551 titles. No studies comparing oxygen versus no oxygen were found. Four RCTs comparing delivery methods and 12 observational studies assessing the accuracy of clinical signs indicating hypoxaemia were eligible. A meta-analysis of the RCTs comparing oxygen delivery methods was performed. Main resultsThree studies assessed the effectiveness of nasal prongs (NP) versus nasopharyngeal catheters (NPC). The pooled estimate effect showed no differences (OR 0.96; 95% CI 0.48 to 1.93) in treatment failure (number of children failing to achieve adequate SaO2). One study compared the effectiveness of NP versus nasal catheter (NC). No differences were found in treatment failure (the mean number of episodes of desaturation/child: NC group 2.75, SD ± 2.18 episodes/child; NP group 3, SD ± 2.5 episodes/child, p = 0.64). Another study compared face mask (FM) and head box (HB) versus NPC. Use of FM showed lower risk of treatment failure (failure to achieve PaO2 > 60 mmHg) than the NPC (OR 0.20; 95% CI 0.55 to 0.88). As did the use of HB compared with NPC (OR 0.40; 95% CI 0.13 to 1.12). Studies assessing the accuracy of signs and/or symptoms indicating hypoxaemia showed that cyanosis, grunting, difficulty in feeding and mental alertness have better specificity in predicting hypoxaemia and its results were consistent among studies. Authors' conclusionsNP and NPC seem to be similar in effectiveness and safety when used in patients with LRTI. There is no single clinical sign or symptom that accurately identifies hypoxaemia. Studies identifying the most effective and safe oxygen delivery method are needed. |