Clinical predictors of acute radiological pneumonia and hypoxaemia at high altitude.

Lozano, Juan Manuel; Steinhoff, Mark C.; Ruíz, Juan Gabriel; Mesa, María Lucia; Martínez, Nathalie Tamayo; Dussan, B

doi:10.1136/adc.71.4.323

Cited by 57 publications

(43 citation statements)

References 17 publications

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“…Various researches have used higher cut-off values than WHO guideline to show association of tachypnoea with hypoxemia. 1,8,18 Respiratory rate of more than 60 per minute (tachypnea) was present in 34% non-hypoxemic than 66% hypoxemic children and the difference was signifi cantly associated with hypoxemia which is corroborated with Basnet et al (2006) 18 reported that respiratory rate of 70 per minute was signifi cantly associated with hypoxemia while Lozano et al (1993) 19 used respiratory rate of 50 per minute in their study to show association of tachypnoea with hypoxemia at high altitude. In present study, it was noted that hypoxemia was signifi cantly associated with age was supported by Basnet et al, revealed that increased chances of pneumonia and frequency of hypoxemia in infants.…”

Section: Discussionsupporting

confidence: 79%

Determinants of hypoxemia in children associated with pneumonia

Ramawat

Sharma

2015

Asian J Med Sci

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Background and Objectives:The most severe manifestation of pneumonia is hypoxemia has been shown to be a risk factor for morbidity and mortality. Authors investigated associating factors and determinants of hypoxemia in children with pneumonia. Materials and Methods: A crosssectional study is designed among children of pediatric outpatient and emergency department that enrolled at Government Multi-Speciality Hospital, Chandigarh. One hundred fi fty children recruited for study. The demographic and clinical parameters were recorded. Oxygen saturation measured by pulse oximeter. Results: The prevalence of hypoxemia was 48% and 61 (84.7%) infants aged 1 year found with hypoxemia. Age (p=0.006), respiratory rate (p=0.001) and severity of pneumonia (p=0.001) were strongly associated with hypoxemia. The prevalence of severe and very severe pneumonia among hypoxemic were 56.1% and 73.7% respectively. Central cyanosis (98.7%), peripheral (98.7%) cyanosis, head nodding (97.4%) grunting (96.15%) were highly specifi c but suprasternal (62.82%), subcostal (43.58%) and intercostal retractions (44.87%) were fairly specifi c sign. Sensitivity for subcostal (81.94%) and intercostal retractions (83.33%) was very high but was fair for intercostal (83.33%) retraction. Grunting (p=0.009), nasal fl aring (p=0.008), subcostal (p=0.001) and intercostal (p=0.000) retractions were strongly but suprasternal retraction was signifi cantly (p=0.024) associated with hypoxemia. Dyspnea (97.22%) was very sensitive while decrease feeding (84.61%) and irritability (83.33%) was highly but lethargy (58.97%) was fairly specifi c symptom. Conclusions: Study suggested that clinical signs and symptoms such as chest wall retraction, decrease feeding, dyspnea, grunting and nasal fl aring in children with pneumonia may be utilized as markers for hypoxemia in conditions where pulse-oximeter isn't available. This study supports the view of hypoxemia was disabling factor in better functional recovery in severity of pneumonia.

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Section: Discussionsupporting

confidence: 79%

Determinants of hypoxemia in children associated with pneumonia

Ramawat

Sharma

2015

Asian J Med Sci

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“…When using this algorithm, children are classified as having pneumonia based on symptoms of coughing, shortness of breath, and elevated respiratory rate; and severity was defined according to the presence or absence of danger signs including chest indrawing, inability to feed, convulsions, lethargy, or stridor at rest [6]. The diagnostic accuracy the algorithm appeared to vary with nutritional status [7,8], age [9], high altitude [10], prevalence of non-severe pneumonia, and prevalence of wheezing [11][12][13]. The sensitivity of this algorithm has varied from 77 to 94 % and specificity from 39 to 98 % across multiple studies [7-10, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

Agreement Between the World Health Organization Algorithm and Lung Consolidation Identified Using Point-of-Care Ultrasound for the Diagnosis of Childhood Pneumonia by General Practitioners

Chavez

Naithani

Gilman

et al. 2015

Lung

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“…At 3750 m in La Oroya, Peru, 83% of children with clinically diagnosed bronchopneumonia (crepitations, diminished breath sounds) were hypoxemic, where hypoxemia was defined as an Sa O 2 ,82% for infants aged 2 to 11 months and ,85% for children 12 months or older (Reuland et al, 1991). Clinical signs, such as tachypnea, cyanosis, grunting, flaring, chest retractions, head nodding and lethargy, were less predictive of hypoxemia and pneumonia at high than low altitude (Reuland et al, 1991;Onyango et al, 1993;Lozano et al, 1994;Dyke et al, 1995). However, hypoxemia as determined by pulse oximetry was relatively sensitive and specific for the diagnosis of pneumonia (Reuland et al, 1991;Onyango et al, 1993;Lozano et al, 1994).…”

Section: Contribution Of Hypoxemia To Respiratory Morbidity and Mortamentioning

confidence: 96%

“…Children with hypoxemia were 4.3 times more likely to die within 5 days than children without hypoxemia (95% CI for relative risk 1.03 to 17.8) (Onyango et al, 1993). In Bogota, Colombia, at 2640 m, 63% of children presenting to an urban emergency room with cough of ,7 days duration were hypoxemic, defined as Sa O 2 ,88%, the 95th percentile of normal (Lozano et al, 1994). At 3750 m in La Oroya, Peru, 83% of children with clinically diagnosed bronchopneumonia (crepitations, diminished breath sounds) were hypoxemic, where hypoxemia was defined as an Sa O 2 ,82% for infants aged 2 to 11 months and ,85% for children 12 months or older (Reuland et al, 1991).…”

Section: Contribution Of Hypoxemia To Respiratory Morbidity and Mortamentioning

confidence: 99%

Cardiopulmonary Transition in the High Altitude Infant

Niermeyer

2003

High Altitude Medicine & Biology

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The perinatal cardiopulmonary transition at high altitude differs from that at sea level because oxygen plays a fundamental role in the developmental changes from fetus to newborn infant. Under conditions of high altitude hypoxia, arterial oxygen saturations are lower, breathing patterns and maturation of respiratory control reflexes differ, and regression of fetal characteristics of the pulmonary vasculature proceeds more slowly. Several aspects of transition vary not only with postnatal age and altitude, but also with population group, suggesting an effect of genetic adaptation on perinatal physiology. Exposure to chronic high altitude hypoxia during the perinatal transition also results in apparent lifelong alterations in respiratory reflex responses and pulmonary vasoreactivity. Disruption of the normal process of cardiopulmonary transition can result in symptomatic high altitude pulmonary hypertension. The exaggerated hypoxemia associated with acute respiratory infections in young infants still undergoing transition contributes to infant mortality at high altitude.

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Clinical predictors of acute radiological pneumonia and hypoxaemia at high altitude.

Cited by 57 publications

References 17 publications

Determinants of hypoxemia in children associated with pneumonia

Determinants of hypoxemia in children associated with pneumonia

Agreement Between the World Health Organization Algorithm and Lung Consolidation Identified Using Point-of-Care Ultrasound for the Diagnosis of Childhood Pneumonia by General Practitioners

Cardiopulmonary Transition in the High Altitude Infant

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