From the Guidelines
Oxygen therapy in pediatric patients is recommended when their oxygen saturation falls below 93% on room air, as this threshold is associated with increased mortality and morbidity, and supplemental oxygen should be initiated to maintain saturations above this level. This recommendation is based on recent studies, including one from Malawi that found an SpO2 threshold of < 93% to be independently predictive of mortality among children with WHO pneumonia 1. Another study also reported that an SpO2 < 90% is predictive of mortality among children with pneumonia, with a pooled OR of death of 5.47 (95% CI, 3.93–7.63) from 13 studies of children with clinical pneumonia and SpO2 < 90% in low-resource settings 1.
Key considerations for oxygen therapy in pediatric patients include:
- Using appropriate-sized equipment to deliver oxygen
- Monitoring saturations continuously to adjust therapy as needed
- Titrating to the lowest effective flow rate to maintain target saturations
- Adding humidification for flow rates above 4 L/min to prevent mucosal drying
- Regular reassessment to adjust therapy based on the child's clinical response and to wean oxygen when appropriate
It's essential to note that the threshold for oxygen therapy may vary based on the child's condition, such as premature infants who may require target saturations of 90-95% to balance oxygen needs while avoiding complications like retinopathy of prematurity. Children with chronic lung diseases may also have individualized targets, sometimes accepting lower saturations of 88-92%. However, the general recommendation for pediatric patients is to initiate oxygen therapy when their oxygen saturation falls below 93% on room air.
From the Research
Oxygen Therapy Thresholds in Pediatric Patients
- The recommended threshold for oxygen therapy in pediatric patients varies depending on the specific condition and disease [(2,3,4)].
- For infants and children with bronchiolitis, a target oxygen saturation of 90-97% is recommended 2.
- For children with respiratory distress, supplemental oxygen is indicated at peripheral oxygen saturation (SpO2) thresholds of 90-94% 3.
- However, some studies suggest that lower SpO2 thresholds, such as 88%, may be safe and effective in reducing hospitalization rates and length of stay [(3,5)].
Disease-Specific Thresholds
- For pediatric patients with bronchiolitis, bronchitis, pneumonia, and asthma, an oxygen saturation target of 90% may be safe after the patient's general condition has improved 4.
- For children with long-term home oxygen therapy, the levels of oxygen saturation indicative for oxygen therapy differ from those established for adults with chronic obstructive pulmonary disease, and vary according to age and disease 6.
Considerations for Oxygen Therapy
- The use of high-flow nasal cannula therapy is safe and more effective than low-flow oxygen to treat infants with moderate to severe bronchiolitis 2.
- The application of humidification with low-flow oxygen delivery is not recommended 2.
- Establishing a patient/disease oxygen therapy target upon admission is considered best practice 2.