Above, photo by Jonathan Hyams, Save the Children, Bangladesh, July 2018: Laila,* holds an oxygen mask to the face of her son Sohai,* two, at Save the Children’s primary healthcare centre (PHCC) in Cox’s Bazar, Bangladesh. Sohai* was admitted to the inpatient ward at the PHCC, suffering from acute pneumonia.
by Kathryn Maitland, Professor of Tropical Paediatric Infectious Diseases at Imperial College, London and KEMRI-Wellcome Trust
Although oxygen is a basic element of hospital care, strongly recommended as a life-saving therapy for children with severe pneumonia and specifically for children with hypoxaemia (oxygen saturations, SpO2 less than 90%), the evidence underpinning these recommendations is weak. Yet, many African hospitals lack the facility to measure oxygen saturations (using pulse oximetry) and thus, therapeutic oxygen is often poorly targeted. Furthermore, despite a high demand, there is often very limited resources of oxygen therapy which is both costly (if using bottled oxygen) and erratic (if using oxygen concentrators) as electricity is unreliable. Although oxygen has been used in supportive treatment for a large part of the last century, the recognition of oxygen toxicity as a problem has been relatively recent. Toxicity is related to the concentration of oxygen and length of exposure. Worldwide, there is an increasing recognition of the harms of oxygen therapy. The evolving literature on its harms has resulted in oxygen no longer being recommended for a number of indications. Thus, there is a justifiable scientific question about whether oxygen can be safely and effectively administered, and results in better outcomes in children with severe pneumonia.