5 - Pediatric Oxygen Therapy

indications for neonatal/pediatric oxygen therapy

• treat/prevent hypoxemia

• support metabolism and tissue oxygenation

• neonates: S_pO₂ below target range, WOB, cyanosis, apnea

• infants/kids: S_pO₂ < 92-94% with distress, acute/chronic lung disease, trauma, CHD, shock

disease-specific applications of oxygen therapy

• neonates

• RDS

• transient tachypnea of the newborn (TTN)

• meconium aspiration syndrome (MAS)

• pneumonia

disease-specific applications of oxygen therapy

• bronchopulmonary dysplasia (BPD)

• long-term O₂

• risk of CO₂ retention

disease-specific applications of oxygen therapy

• pediatrics

• asthma: O₂ during attacks

• bronchiolitis: O₂, HFNC

• CHD: avoid hyperoxia in duct-dependent lesions

developmental respiratory physiology

• fetal Hb: high O₂ affinity

• immature lungs: low C_L, high closing volumes

• preterm: limited antioxidants, more vulnerable to O₂ toxicity

manifestations of hypoxemia

• respiratory: tachypnea, grunting, retractions

• CV: brady-/tachycardia, poor perfusion

• neuro: irritability, poor feeding

target S_pO₂ ranges

• neonates: 90-95% (avoid prolonged > 97%)

• preterm: 88-94%

• kids: ≥ 92%

pediatric oxygen principles

• start low, go slow

• pre-/postductal monitoring

• continuous monitoring and humidity

pediatric O₂ devices

• nasal cannula

• mask

• HFNC

• hoods/incubators (neonates)

estimating and managing pediatric F_iO₂

• NC: ~4% F_iO₂ increase per L/min

• variable vs. fixed F_iO₂

• O₂ analyzer

choosing right pediatric O₂ delivery system

based on age, comfort, condition

indications for heated high-flow nasal cannula (HHFNC)

• hypoxemia and mild to moderate respiratory distress

• usually used in the ED and ICU

hazards of HHFNC

• can’t measure distending pressures

• needs electricity to work

hazards of O₂ therapy

• retinopathy of prematurity (ROP)

  • avoid S_pO₂ > 95%

• O₂ toxicity: lung injury

• absorption atelectasis

• CO₂ retention (BPD)

O₂ monitoring and documentation

• alarms

• continuous S_pO₂

• O₂ analyzer

• weaning: decrease F_iO₂ in 2-5% steps