Paeds · respiratory-sleep-and-airway
Oxygen therapy and home oxygen in children
Also known as Oxygen therapy in children · Supplemental oxygen · Home oxygen · Long-term oxygen therapy · LTOT · Domiciliary oxygen · Oxygen delivery devices · Nasal cannula · High-flow nasal cannula · Oxygen saturation targets
Fellowship guide to oxygen therapy and home oxygen in children: how to treat hypoxaemia safely without tipping a child into hyperoxia. The page covers the oxygen delivery devices from low-flow nasal cannula through high-flow nasal cannula, Venturi and non-rebreather masks to head boxes, the saturation targets that differ between the acutely unwell child, the extremely preterm neonate and the child with cyanotic heart disease, the physiology of the oxyhaemoglobin dissociation curve that makes those targets matter, the criteria and equipment for discharging a child on home oxygen, and the structured weaning that gets a child off oxygen safely.
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- A rising oxygen requirement is a deterioration until proven otherwise — a child who needs steadily more oxygen to hold the same saturation is heading towards respiratory failure, so escalate and find the cause rather than simply turning up the flow
- Oxygen is a treatment for hypoxaemia, not for breathlessness or a low number in a well-perfused child — treat the disease, and never let a normal saturation on high oxygen reassure you that the child is safe
- In a child with chronic hypercapnic respiratory failure or central hypoventilation, oxygen alone can raise the saturation while carbon dioxide climbs to narcosis — ventilate, do not merely oxygenate, and monitor carbon dioxide
- In the extremely preterm neonate, both too little and too much oxygen cause harm — uncontrolled high oxygen drives retinopathy of prematurity and oxidative injury, so target the prescribed saturation band and blend oxygen with air
- Silent hypoxaemia is common in children — a child with pneumonia or bronchiolitis can be dangerously hypoxaemic without obvious distress, so measure the saturation rather than trust appearances
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- Oxygen therapy and the assessment of hypoxaemia
- Oxygen delivery devices and their use in children
- Pulse oximetry and its limitations
- Oxygen saturation targets across age and disease
- Home oxygen programmes for chronic lung disease
- Weaning long-term oxygen therapy
- The hypoxaemic child and safe oxygen use
- Home and long-term oxygen therapy
- Oxygen in chronic neonatal lung disease
- Long case: the technology-dependent child on home oxygen
- Short case: the child with chronic lung disease and oxygen
- Respiratory and sleep medicine: oxygen therapy
- Chronic respiratory support in the community
- Oxygen therapy, saturation targets and devices
- Home oxygen indications and weaning
- Assessment of the child on home oxygen
- Oxygen therapy and respiratory support
- Bronchopulmonary dysplasia and home oxygen
- Neonatal oxygen targeting
- Patient Care: oxygen therapy and management of hypoxaemia
- Medical Expert: oxygen therapy and home oxygen in children
Overview & Definition
A child with pneumonia sits quietly in a parent's lap, pink lips, not obviously struggling, and yet the pulse oximeter reads eighty-eight per cent. Oxygen therapy is the treatment for that gap between how a child looks and how well their blood is actually carrying oxygen: it is the delivery of a gas at a higher concentration than room air to correct hypoxaemia, and its whole purpose is to keep tissue oxygen delivery adequate while the underlying illness is treated. [3] [10]
Oxygen is a drug, and like any drug it has a target, a dose and a toxicity. The target is a saturation band, not the highest number obtainable; the dose is the flow and concentration needed to reach that band; and the toxicity is the harm of hyperoxia, which matters most in the newborn. This framing separates the two commonest errors in paediatric practice, which are leaving a hypoxaemic child untreated because they do not look distressed, and drowning a child in oxygen far above the target because more seems safer. [3] [7]
Home oxygen is the same drug carried into the community for the child whose lungs or circulation cannot yet maintain safe saturations on room air, most often after extreme prematurity. It converts a hospital dependence into a life at home, but it demands stability, the right equipment, trained carers and a plan to wean, so that the child is neither discharged unsafely nor kept on oxygen a day longer than needed. [1] [2]
References11ShowHide
- [1]Hayes D Jr; Wilson KC; Krivchenia K; et al Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med, 2019.PMID 30707039
- [2]Balfour-Lynn IM; Field DJ; Gringras P; et al BTS guidelines for home oxygen in children. Thorax, 2009.PMID 19586968
- [3]O'Driscoll BR; Howard LS; Earis J; et al BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax, 2017.PMID 28507176
- [4]Cunningham S; Rodriguez A; Adams T; et al Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet, 2015.PMID 26382998
- [5]Franklin D; Babl FE; Schlapbach LJ; et al A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med, 2018.PMID 29562151
- [6]Rojas-Reyes MX; Granados Rugeles C; Charry-Anzola LP Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age. Cochrane Database Syst Rev, 2014.PMID 25493690
- [7]Askie LM; Darlow BA; Finer N; et al Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration. JAMA, 2018.PMID 29872859
- [8]Manja V; Lakshminrusimha S; Cook DJ Oxygen saturation target range for extremely preterm infants: a systematic review and meta-analysis. JAMA Pediatr, 2015.PMID 25664703
- [9]Saugstad OD; Aune D Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation target studies. Neonatology, 2014.PMID 24247112
- [10]Graham HR; King C; Duke T; et al Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care. Lancet Glob Health, 2024.PMID 38914087
- [11]Franklin D; Babl FE; Neutze J; et al Predictors of Intensive Care Admission in Hypoxemic Bronchiolitis Infants, Secondary Analysis of a Randomized Trial. J Pediatr, 2023.PMID 36528052