Benefits and risks Antibiotics use in the management of severe acute malnutrition

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10. Evidence for recommendations on the oxygen use and delivery

10.1 Pulse oximetry for detection of hypoxaemia

1. Pulse oximetry is recommended to determine the presence of hypoxaemia and to guide administration of oxygen therapy in all infants and children with hypoxaemia. Strong recommendation, low quality evidence he panel noted that although there are no studies comparing arterial blood gases versus pulse oximetry in children, the meta-analysis in adults shows a very high correlation. Pulse oximetry is non-invasive, feasible to implement, and does not require any special skills. It is, therefore, more suitable for use more widely.

10.1.1 Evidence and summary of findings

A systematic review of the accuracy of pulse oximetry in children was not found. A meta-analysis of 74 studies of adult subjects, published between 1976-1994, reported the correlation between pulse oximetry measurements and arterial blood gas ABG analysis, and investigated how a number of factors afected this relationship [Jensen, 1998] see GRADE table A7.28 . he available low quality evidence shows that pulse oximetry is the best non-invasive method of detecting hypoxaemia, and should be made globally available. Subjects included in the studies were healthy adult volunteers 25.7, respiratory patients 20.3, cardiac and thoracic surgical patients 18.9, critically ill patients 16.2, and athletes 5.4. Of 39 studies that reported suicient data on the number of subjects and data points to calculate the correlation coeicient r between pulse oximetry and ABG, the weighted mean r was 0.895 +- 0.014. his estimate did not signiicantly change when only higher quality studies were considered r = 0.883. he highest correlation was in healthy volunteers r = 0.957, and the lowest in critically ill patients r = 0.760. he accuracy of oximeters difered depending on the oximeter make, particularly at saturations below 70. Finger probes were found to have a signiicantly higher correlation with SaO 2 than ear probes p 0.0001. he correlation coeicient in ive studies of hypoxic subjects SaO 2 67.6 -87.8 was high r = 0.938. Factors that reduced accuracy included dyshemoglobinemia, hypothermia, and skin pigmentation.