Oxygen and pulse oximetry in childhood pneumonia: surveys of clinicians and student clinicians in Cambodia

Ginsburg, Amy Sarah; Gerth‐Guyette, Emily; Mollis, Brenda; Gardner, Michelle; Samnang, Chham

doi:10.1111/tmi.12291

Cited by 13 publications

(14 citation statements)

References 12 publications

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“…Our findings are from paediatric areas within medium-sized Nigerian hospitals and may be less relevant outside this context. However, poor oximetry practices are common in hospitals throughout the world, particularly in low-income and middle-income countries,12–16 and our realist evaluation approach enables many lessons to be shared. Our study looked specifically at oximetry; however, our findings may be relevant to the introduction of other care practices, particularly those that involve the introduction of new health technologies.…”

Section: Discussionmentioning

confidence: 99%

“…Feasibility studies have shown that nurses and community health workers are able to use pulse oximeters effectively 10 11. However actual use of oximetry remains low—even when pulse oximeters are available 12–16. Experience from previous oximetry implementation projects suggests that while oximetry itself is not complicated, integrating oximetry into routine care practices is complex,17–19 requiring substantial behaviour change, and being influenced by a range of individual, social and environmental influences 20…”

Section: Introductionmentioning

confidence: 99%

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Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation

et al. 2018

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IntroductionPulse oximetry is a life-saving tool for identifying children with hypoxaemia and guiding oxygen therapy. This study aimed to evaluate the adoption of oximetry practices in 12 Nigerian hospitals and identify strategies to improve adoption.MethodsWe conducted a mixed-methods realist evaluation to understand how oximetry was adopted in 12 Nigerian hospitals and why it varied in different contexts. We collected quantitative data on oximetry use (from case notes) and user knowledge (pretraining/post-training tests). We collected qualitative data via focus groups with project nurses (n=12) and interviews with hospital staff (n=11). We used the quantitative data to describe the uptake of oximetry practices. We used mixed methods to explain how hospitals adopted oximetry and why it varied between contexts.ResultsBetween January 2014 and April 2017, 38 525 children (38% aged ≤28 days) were admitted to participating hospitals (23 401 pretraining; 15 124 post-training). Prior to our intervention, 3.3% of children and 2.5% of neonates had oximetry documented on admission. In the 18 months of intervention period, all hospitals improved oximetry practices, typically achieving oximetry coverage on >50% of admitted children after 2–3 months and >90% after 6–12 months. However, oximetry adoption varied in different contexts. We identified key mechanisms that influenced oximetry adoption in particular contexts.ConclusionPulse oximetry is a simple, life-saving clinical practice, but introducing it into routine clinical practice is challenging. By exploring how oximetry was adopted in different contexts, we identified strategies to enhance institutional adoption of oximetry, which will be relevant for scale-up of oximetry in hospitals globally.Trial registration numberACTRN12617000341325.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation

et al. 2018

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“…Pulse oximetry, the ‘fifth pediatric vital sign’ [ 19 ] supplemented by treatment with oxygen was found to be a feasible and cost effective intervention for childhood pneumonia with 35% reduction in mortality in Papua New Guinea [ 20 ]. Unfortunately even though pulse oximeters and oxygen are available, they are underutilized by health workers in developing countries [ 21 , 22 ]. Pulse oximetry to document hypoxia in community acquired pneumonia is not only endorsed by professional societies in developed countries [ 23 , 24 ] but also stated in recent WHO guidelines[ 6 ] and our findings support these recommendations.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Duration and Treatment Failure of Severe Pneumonia in Hospitalized Young Nepalese Children

et al. 2015

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BackgroundPneumonia in young children is still the most frequent cause of death in developing countries. We aimed to identify predictors for recovery and treatment failure in children hospitalized with severe pneumonia.MethodsWe enrolled 610 Nepalese children, aged 2 – 35 months from February 2006 to June 2008. Study participants were provided with standard treatment for pneumonia and followed up until discharge. Three multiple regression models representing clinical variables, clinical and radiological combined and all variables, including C-reactive protein (CRP) and viral etiology were used to assess the associations.ResultsThe median age of study participants was 6 months with 493 (82%) infants and 367 (61%) males. The median time (IQR) till recovery was 49 (31, 87) hours and treatment failure was experienced by 209 (35%) of the children. Younger age, hypoxia on admission and radiographic pneumonia were independent predictors for both prolonged recovery and risk of treatment failure. While wasting and presence of any danger sign also predicted slower recovery, Parainfluenza type 1 isolated from the nasopharynx was associated with earlier resolution of illness. Gender, being breastfed, stunting, high fever, elevated CRP, presence of other viruses and supplementation with oral zinc did not show any significant association with these outcomes.ConclusionAge, hypoxia and consolidation on chest radiograph were significant predictors for time till recovery and treatment failure in children with severe pneumonia. While chest radiograph is not always needed, detection and treatment of hypoxia is a crucial step to guide the management of hospitalized children with pneumonia.

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“…Despite this, evidence on the uptake of pulse oximetry in LMIC is limited. Available estimates suggests it remains low, ranging from less than 30% to more than 70% across different LMIC settings . There are examples of pulse oximeter implementation being feasible in LMIC settings, including Malawi and Nigeria, and resulting in improved referral decision‐making .…”

Section: Introductionmentioning

confidence: 99%

Performance of a novel reusable pediatric pulse oximeter probe

King

Mvalo

Sessions

et al. 2019

Pediatric Pulmonology

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Objective To assess the performance of reusable pulse oximeter probe and microprocessor box combinations, of varying price‐points, in the context of a low‐income pediatric setting. Methods A prospective, randomized cross‐over study comparing time to biologically plausible oxygen saturation (SpO2) between: (1) Lifebox LB‐01 probe with Masimo Rad‐87 box (L + M) and (2) a weight‐appropriate reusable Masimo probe with Masimo Rad‐87 box (M + M). A post hoc secondary analysis comparison with historical usability testing data with the Lifebox LB‐01 probe and Lifebox V1.5 box (L + L) was also conducted. Participants, children aged 0 to 35 months, were recruited from pediatric wards and outpatient clinics in the central region of Malawi. The primary outcome was time taken to achieve a biologically plausible SpO 2 measurement, compared using t tests for equivalence. Results We recruited 572 children. Plausible SpO2 measurements were obtained in less than 1 minute, 71%, 70%, and 63% for the M + M, L + M, and L + L combinations, respectively. A similar pattern was seen for less than 2 minutes, however, this effect disappeared at less than 5 minutes with 96%, 96%, and 95% plausible measurements. Using a ±10 second threshold for equivalence, we found L + M and M + M to be equivalent, but were under‐powered to assess equivalence for L + L. Conclusions The novel reusable pediatric Lifebox probe can achieve a quality SpO2 measurement within a pragmatic time range of weight‐appropriate Masimo equivalent probes. Further research, which considers the cost of the devices, is needed to assess the added value of sophisticated motion tolerance software.

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Oxygen and pulse oximetry in childhood pneumonia: surveys of clinicians and student clinicians in Cambodia

Cited by 13 publications

References 12 publications

Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation

Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation

Predictors of Duration and Treatment Failure of Severe Pneumonia in Hospitalized Young Nepalese Children

Performance of a novel reusable pediatric pulse oximeter probe

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