Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age

  • Review
  • Intervention

Authors

  • Maria Ximena Rojas-Reyes,

    Corresponding author
    1. Pontificia Universidad Javeriana, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Bogota, DC, Colombia
    • Maria Ximena Rojas-Reyes, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Cr. 7 #40-62, 2nd floor, Bogota, DC, Colombia. mxrojas@gmail.com. mxrojas@javeriana.edu.co.

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  • Claudia Granados Rugeles,

    1. Pontificia Universidad Javeriana, Department of Paediatrics, Faculty of Medicine, Bogota, DC, Colombia
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  • Laura Patricia Charry-Anzola

    1. Pontificia Universidad Javeriana, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Bogota, DC, Colombia
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Abstract

Background

Usual 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.

Objectives

To determine in the treatment of LRTIs:
the effectiveness of oxygen therapy and oxygen delivery methods;
the safety of these methods; and
indications for oxygen therapy.

Search methods

We 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 criteria

Randomised 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 analysis

We 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 results

Three 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' conclusions

NP 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.

摘要

背景

3個月至15歲下呼吸道感染兒童的氧氣治療

下呼吸道感染(lower respiratory tract infections;LRTIs)的一般治療包括氧氣的給予。對於氧氣治療本身及不同的氧氣給予方式之效果目前並不清楚。這篇文章有助於合理使用氧氣治療下呼吸道感染。

目標

要確定在下呼吸道感染的治療:氧氣治療的有效性和氧氣給予方法;這些方法的安全性和氧氣治療的適應症。

搜尋策略

我們檢索了Cochrane Central Register of Controlled TrialsTrials(CENTRAL The Cochrane Library, 2008, issue 2)資料庫;同時也搜尋了MEDLINE檢索(1966年1月至2008年3月),EMBASE資料庫(1990年至2007年12月)和LILACS(1982年1月至2008年3月)。

選擇標準

隨機對照試驗(RCT)在低氧血症下呼吸道感染兒童(3個月至 15歲)比較氧氣治療與無氧氣治療或氧氣的給予方式。 觀察研究被納入來確定使用氧氣治療的適應症。

資料收集與分析

我們評估 551個標題。 沒有研究在比較氧氣治療與無氧氣治療。 4個隨機對照試驗比較氧氣給予方式和12個觀測研究在評估顯示低氧血症之臨床徵象的準確性。 比較氧氣輸送方式進行了隨機對照試驗綜合分析。

主要結論

3項研究評估鼻翼管(NP)與鼻咽 導管(NPC)的成效。 匯集資料顯示在治療失敗族群(無法達到足夠的血氧的兒童)兩組並無明顯差異(OR 0.96; 95% CI 0.48 to 1.93)。 一項研究比較鼻翼管與鼻導管(NC;nasal catheter)的效益。結果顯示在治療失敗的兒童,兩組之間並沒有差異(平均低血氧的發作次數 /兒童:NC組2.75,標準差�2.18次/兒童; NP組3,標準差�2.5次/兒童,P值0.64)。 另一項研究比較面罩(face mask;FM),頭盒(head box ;HB)和鼻咽導管。 使用面罩治療失敗(血氧無法到達60毫米汞柱)的風險比使用鼻咽管低(OR 0.20; 95% CI 0.55 to 0.88)。 使用頭盒治療失敗的風險比使用鼻咽管低(OR 0.40; 95% CI 0.13 to 1.12)。 研究評估象徵低血氧症狀及徵象的準確性;發紺,呼嚕聲,餵養困難和精神警覺在預測低血氧有較好的特異性並與研究結果是一致的。

作者結論

鼻導管和鼻咽管用於治療下呼吸道感染病人時,有效性和安全性是類似的。沒有單一的臨床跡象或症狀可以準確地識別低氧血症。研究確定最有效和最安全的氧氣輸送方法是必要的。

翻譯人

本摘要由臺灣大學附設醫院陳鍾岳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

氧氣療法在治療下呼吸道感染的兒童 是作為一種補充療法:這篇文章的主要目的是確定對於下呼吸道感染(LRTIs)康復的兒童,非侵入性氧輸送系統的有效性和安全性。其他目標是確定氧氣治療的適應症,結束氧氣治療的臨床標準,確定出院後繼續使用氧氣治療的適應症,並估算不同氧氣輸送方式的相關費用。 為了回答這些問題,我們對於氧氣療法治療下呼吸道感染的兒童進行了廣泛的搜索隨機對照試驗(RCTs)。 我們沒有找到任何比較氧氣與沒有氧氣的試驗。 只有4個隨機對照試驗和1個系統回顧符合所有標準。 已知證據表示,針對下呼吸道感染兒童鼻翼管可能比鼻咽管和鼻導管更有效運送氧氣,特別因為鼻翼管很少有間接影響,亦無嚴重不良反應。然而,分析治療失敗和不良事件風險的95%信賴區間(CI),表現出缺乏精確性。 沒有足夠證據以確定哪些非侵入性的氧氣方式可用於治療兒童的低血氧下呼吸道感染。 我們沒有發現任何臨床症狀,典型或評分系統可準確地識別低氧血症兒童。 由於不同機構資源之間的差異,在選擇最佳的非侵入性氧給予方式治療低血氧下呼吸道感染的兒童時,患者耐受性,病人安全,成本和可用性時都必須考慮。 為了幫助醫護人員作最好的決定,研究旨在找出最有效和安全的非侵入性氧給予方法。 進一步的研究必須考慮療效,耐受性,安全性和成本。

Plain language summary

Oxygen therapy is used as a complementary therapy in the treatment of lower respiratory tract infections in children

The 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 .

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