Elsevier

The Journal of Pediatrics

Volume 127, Issue 3, September 1995, Pages 378-383
The Journal of Pediatrics

Comparison of nasal prongs and nasopharyngeal catheter for the delivery of oxygen in children with hypoxemia because of a lower respiratory tract infection,☆☆,,★★

https://doi.org/10.1016/S0022-3476(95)70067-6Get rights and content

Abstract

Objective: To determine the best method of oxygen delivery for children in developing countries who have hypoxemia caused by acute lower respiratory tract infection. Methods: One hundred eighteen children between 7 days and 5 years of age with a lower respiratory tract infection and arterial hemoglobin oxygen saturation (SaO2) less than 90% were randomly selected to receive oxygen by nasopharyngeal (NP) catheter (n = 56) or nasal prongs (n = 62). A crossover study to determine the flow rate necessary to achieve an SaO2 of 95% was performed in 60 children. Results: One hundred twelve children could be oxygenated by the allocated method; in six oxygenation was poor with either method. The mean duration of therapy was 87.5 hours for the prongs and 94.9 hours for the NP catheter (not significant). The median oxygen consumption was 2142 L for prongs and 1692 L for the NP catheter (not significant). In the crossover study the prongs needed, on average, 26% higher oxygen flow rates than the NP catheter to obtain an SaO2 of 95% (p = 0.003). Complete nasal obstruction was observed in 24 of the children (44%) in the NP catheter group and in 8 (13%) in the prongs group (p <0.001). Eighteen children died, 11 with NP catheter and 7 with prongs (not significant). Conclusions: Because nasal prongs are less prone to complications, and oxygenation in children is equally effective, they are a more appropriate method than the NP catheter for oxygen delivery to children in developing countries with acute lower respiratory tract infections. (J PEDIATR 1995;127:378-83)

Section snippets

Patients

The study was performed in the pediatric ward of the Royal Victoria Hospital in Banjul, the only pediatric referral hospital in The Gambia. In the first year of the study, children with a provisional diagnosis of pneumonia or bronchiolitis were assessed by a trained field assistant. The SaO2, respiratory rate, and temperature were measured. During the second year of the study, all children admitted to the hospital were screened in this way. Children with pneumonia or bronchiolitis who were not

Patients

One hundred twenty—three patients with an SaO2 less than 90% were initially assessed. Five children were excluded-three with cyanotic congenital heart disease and two with central hypopnea and gasping. Thus 118 children were enrolled into the study. Sixty-four of the children (54%) were male. The median age of the study patients was 5 months, with a range from 10 days to 58 months. Ninety-six children had a diagnosis of pneumonia. Of these, 13 had measles as a previous or concurrent illness, 8

DISCUSSION

Both the NP catheter and the nasal prongs produce adequate oxygenation with relatively low oxygen flow rates in the majority of children with hypoxemia. We did not find any patient who could be oxygenated with one of the systems and not with the other. However, some patients needed several hours of therapy to reach an SaO2 of 95%. This might indicate intrapulmonary shunting, which decreased as a result of antibiotic or oxygen therapy. In most hospitals in developing countries, oxygen will be

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From the Medical Research Council Laboratories, Fajara, The Gambia; Children's Hospital, Hannover Medical School, Hannover, Germany; and Royal Victoria Hospital, Banjul, The Gambia

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Supported by the World Health Organization Programme for the Control of Acute Respiratory Infections.

Reprint requests: Martin Weber, MD, Medical Research Council Laboratories, PO Box 273, Fajara, Banjul, The Gambia, West Africa.

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0022-3476/95/$5.00 + 0 9/20/64855

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