Oxygen therapy and home oxygen in children — formative SAQs

SAQ 1 — The infant with bronchiolitis and a borderline saturation (10 marks, 15 minutes)

A four-month-old infant is admitted with bronchiolitis. He is feeding, alert and has mild recession, and his oxygen saturation is ninety per cent in air on a good pulse oximeter trace. Overnight the nurse asks whether he needs oxygen, and by morning he needs an increasing flow through a nasal cannula to hold the same saturation. [4]

a) What oxygen saturation target would you set for this infant, and what does the trial evidence in bronchiolitis show about a target of ninety per cent compared with ninety-four per cent? (3 marks) [4] [6]

b) He now needs steadily more oxygen to hold his saturation. What does this rising oxygen requirement signify, and how does it change your assessment and plan? (4 marks) [11] [5]

c) List three limitations of the pulse oximeter that you must keep in mind when using it to guide oxygen therapy in children. (3 marks) [10] [3]