Paeds SAQs · respiratory-sleep-and-airway
Oxygen therapy and home oxygen in children — formative SAQs
Two formative SAQs on oxygen therapy in children: an infant with bronchiolitis and a borderline saturation, testing the saturation target, the pulse oximeter's limits and when a rising oxygen requirement means escalation; and an ex-preterm infant with chronic lung disease being considered for home oxygen, testing the readiness criteria, the equipment and safety, and the structured weaning.
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Target exams
SAQ 1 — The infant with bronchiolitis and a borderline saturation (10 marks, 15 minutes)
A four-month-old infant is admitted with bronchiolitis. He is feeding, alert and has mild recession, and his oxygen saturation is ninety per cent in air on a good pulse oximeter trace. Overnight the nurse asks whether he needs oxygen, and by morning he needs an increasing flow through a nasal cannula to hold the same saturation. [4]
a) What oxygen saturation target would you set for this infant, and what does the trial evidence in bronchiolitis show about a target of ninety per cent compared with ninety-four per cent? (3 marks) [4] [6]
b) He now needs steadily more oxygen to hold his saturation. What does this rising oxygen requirement signify, and how does it change your assessment and plan? (4 marks) [11] [5]
c) List three limitations of the pulse oximeter that you must keep in mind when using it to guide oxygen therapy in children. (3 marks) [10] [3]
SAQ 2 — The ex-preterm infant considered for home oxygen (10 marks, 15 minutes)
A former twenty-six-week infant, now approaching discharge, has chronic lung disease of prematurity and still needs a low flow of nasal cannula oxygen to keep saturations in the target band, particularly during sleep and feeding. She is feeding well and gaining weight. The family asks whether she can go home on oxygen. [1]
a) What criteria must be met before this infant is discharged on home oxygen? (4 marks) [1] [2]
b) What equipment and safety measures must be in place at home, and why is the fire risk important? (3 marks) [2] [1]
c) Outline how you would wean her home oxygen and monitor the process. (3 marks) [2] [1]
References
- [1]Hayes D Jr; Wilson KC; Krivchenia K; et al Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med, 2019.PMID 30707039
- [2]Balfour-Lynn IM; Field DJ; Gringras P; et al BTS guidelines for home oxygen in children. Thorax, 2009.PMID 19586968
- [3]O'Driscoll BR; Howard LS; Earis J; et al BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax, 2017.PMID 28507176
- [4]Cunningham S; Rodriguez A; Adams T; et al Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet, 2015.PMID 26382998
- [5]Franklin D; Babl FE; Schlapbach LJ; et al A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med, 2018.PMID 29562151
- [6]Rojas-Reyes MX; Granados Rugeles C; Charry-Anzola LP Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age. Cochrane Database Syst Rev, 2014.PMID 25493690
- [7]Askie LM; Darlow BA; Finer N; et al Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration. JAMA, 2018.PMID 29872859
- [8]Manja V; Lakshminrusimha S; Cook DJ Oxygen saturation target range for extremely preterm infants: a systematic review and meta-analysis. JAMA Pediatr, 2015.PMID 25664703
- [9]Saugstad OD; Aune D Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation target studies. Neonatology, 2014.PMID 24247112
- [10]Graham HR; King C; Duke T; et al Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care. Lancet Glob Health, 2024.PMID 38914087
- [11]Franklin D; Babl FE; Neutze J; et al Predictors of Intensive Care Admission in Hypoxemic Bronchiolitis Infants, Secondary Analysis of a Randomized Trial. J Pediatr, 2023.PMID 36528052