Introducing pulse oximetry for outpatient management of childhood pneumonia: An implementation research adopting a district implementation model in selected rural facilities in Bangladesh

Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis

“…For example, most infectious disease-related deaths are due to sepsis, and sepsis bundles have been shown to reduce mortality ( 51 – 53 ). Respiratory conditions can progress to respiratory failure and death; effective management includes pulse oximetry, oxygen therapy, and non-invasive and invasive ventilation ( 5 , 54 ). Gastrointestinal illnesses can progress to severe dehydration and death, which can be treated with oral rehydration solution and/or intravenous fluids (IVF) ( 50 ).…”

Risk and accuracy of outpatient-identified hypoxaemia for death among suspected child pneumonia cases in rural Bangladesh: a multifacility prospective cohort study

“… 23 User error, poor probe fit, movement artifact, or device malfunction might account for some of these failed measurements, but this effect is likely to be small, as has been previously observed in pilot implementation research from Bangladesh and other settings. 31 , 32 , 33 Another key explanation for measurement failure could be inadequate peripheral perfusion from unrecognised shock. Current WHO IMCI danger signs do not have any specific clinical sign for impaired perfusion, 9 which is both a recognised clinical sign of shock and can lead to pulse oximeter measurement failure.…”

Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care

“… 27 However, although routinely conducted pulse oximetry is increasingly recognised as a standard of care in hospitals, there have been questions about feasibility, effectiveness, and cost in extending pulse oximetry services to primary care and outpatient facilities. To date, there have been few examples of successful implementation of pulse oximetry in primary care settings 28 , 29 (although large-scale roll-outs are underway in an increasing number of countries 30 ) and core barriers and implementation questions need to be resolved. First, staff capacity and workload challenges need to be addressed; paediatric oximetry measurements often take 1–2 min to achieve and potentially shift time away from other activities in a busy clinical context (even in primary care settings).…”