Clinical predictors of hypoxemia in pneumonia
Keywords:
pneumonia, hypoxemia, oxygen saturation, cyanosis, nasal flaring
Abstract
Background Pneumonia is one of the main causes of death ininfants in developing countries. The device of oxygen saturation
measurement for detecting hypoxemia is limited in district hospi-
tals.
Objective The aim of our study was to find the best clinical pre-
dictor for hypoxemia that could be used in Indonesia.
Methods Between June 2001 until May 2002, the diagnostic test
was performed in 125 infants aged 2–12 month-old who suffered
from pneumonia. The oxygen saturation measured by pulse oxim-
etry was used as the gold standard.
Results The samples were divided into two groups, 52 infants with
hypoxemia and 73 normal. The base characteristics of both groups
were not statistically different. The prevalence of hypoxemia was
41.6%. The best single clinical predictor of hypoxemia was cyano-
sis (the sensitivity 92%, specificity 86%, likelihood ratio 6.74, post-
test probability 83%), as well as the combination of two clinical
predictors i.e., cyanosis and nasal flaring. The best combination of
three clinical predictors was cyanosis, nasal flaring, and refusal to
drink (the sensitivity 92%, specificity 86%, likelihood ratio 6.74,
post-test probability 81%).
Conclusion The combination of cyanosis and nasal flaring is
good enough as a predictor to detect hypoxemia in area with no
facility of oxygen saturation measurement
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Morriss FC, Moore GC, editors. A practical guide to
pediatric intensive care. 2 nd ed. St Louis: The CV
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asthma. Illionis: American College of Chest Physicians
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Med Ass J 1992;146:703-12.
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1998 Mar. Available from: URL: CE Handbook: http:/
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respiratory pathology. In: Kendig EL, Chernick V, edi-
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donesia.
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pada bayi dan anak. In: Putra ST, Advani N,
Rahayoe AU, editors. Dasar-dasar diagnosis dan
tatalaksana penyakit jantung pada anak. Jakarta:
Forum Ilmiah Kardiologi Anak Indonesia; 1996. p.
49-62.
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kekurangan energi protein pada anak di rumah sakit
kabupaten/kodya. Jakarta; 1998. lampiran 9.
28. Rab T. Prinsip gawat paru. 2 nd ed. Jakarta: EGC; 1996. p.
75-361.
29. Spooner V, Barker J, Tulloch S, Lehmann D, Marshall
TF, Kajoi M et al. Clinical signs and risk factors associ-
ated with pneumonia in children admitted to Goroka
Hospital, Papua New Guinea. J Trop Pediatr 1989;
35:295-300.
30. Margolis PA, Ferkol TW, Marsocci S, Super DM, Keyes
LL, McNutt R, et al. Accuracy of the clinical exami-
nation in detecting hypoxemia in infants with respira-
tory illness. J Pediatr 1994; 124:552-60.
akut pada anak: tatalaksana kasus di sarana kesehatan
rujukan. Jenewa; 1997. p. 1-5.
2. Weber MW, Usen S, Palmer A, Jaffar S, Mulholland
EK. Predictors of hypoxaemia in hospital admissions
with acute lower respiratory infection in a developing
country. Pediatrics 1997; 76:310-4.
3. Onyango FE, Steinhoff MC, Wafula EM, Wariua S,
Musia J, Kitonyi J. Hypoxaemia in Young Kenyan chil-
dren with acute lower respiratory infection. Br Med J
1993;306:612-5.
4. Dyke T, Lewis D, Heegard W, Manary M, Flew S,
Rudeen K. Predicting hypoxia in children with acute
lower respiratory infection: a study in The Highlands
of Papua New Guinea. J Trop Pediatr 1995;41:196-201.
5. Green M. Pediatric diagnosis, interpretation of symp-
toms & signs in infants, children and adolescents. 5 th
ed. Philadelphia: WB Saunders Company; 1992. p.
343-82.
6. Thompson AE. Respiratory distress. In: Fleisher GR,
Ludwig S, Silverman BK, editors. Synopsis of pediatric
emergency medicine. Baltimore: Williams & Wilkins;
1996. p. 228-32.
7. Moore GC. Acute respiratory failure. In: Levin DL,
Morriss FC, Moore GC, editors. A practical guide to
pediatric intensive care. 2 nd ed. St Louis: The CV
Mosby Company; 1984. p. 58-62.
8. Flenley DC. Blood gas abnormalities andacute respi-
ratory failure. In: Stein M, editor. New directions in
asthma. Illionis: American College of Chest Physicians
Park Ridge; 1975. p. 495-509.
9. Glover DW, McCarthy M. Respiratory therapy. St
Louis: Mosby; 1987. p. 183-202.
10. Technology Subcommittee of the Working Group on
Critical Care. Noninvasive blood gas monitoring: a
review for use in the adult critical care unit. Can
Med Ass J 1992;146:703-12.
11. Patricia A, McGaffigan RN. Hazards of hypoxemia:
how to protect your patient from low oxygen levels.
1998 Mar. Available from: URL: CE Handbook: http:/
/www.haz.hypox/nurs.CE/hand/book.html.
12. Brodovich HMO, Chernick V. The Fungsional basis of
respiratory pathology. In: Kendig EL, Chernick V, edi-
tors. Disorders of the respiratory tract in children. Phila-
delphia: WB Saunders; 1983. p. 3-45.
13. Nehrenz GM. Altitude and oxygenation. 2000 Peb.
Available from: The Journal of Aeromedical Transpor-
tation: http://www. ispub.com/journals/IJAMT/
altox.html.
14. Modares N. Pulmonary system. 1998 Mar. Available
from: URL: Instruction nursing of respiratory: http://
www2.kumc.edu/ instruction/nursing/nrs 812/respira-
tory 2/ index.html.
15. Pagtakhan RD, Pasterkamp H. Intensive care for res-
piratory disorders. In: Chernick V, Kendig EL, editors.
Disorders of the respiratory tract in children. 5 th ed.
Philadelphia: WB Saunders; 1990. p. 205-23.
16. Curiel R, Tortoledo F, Rodriguez L, Soto R, Gonzalez
JP. The cardiovascular effects of acute hypoxemia as a
diagnostic aid. Chest 1977; 81:159-65.
17. Phillips BA, McConnell JW, Smith MD. The effects of
hypoxaemia on cardiac output: A dose-response curve.
Chest 1988; 93:471-5.
18. Brown CW, Gutierrez G. Pulmonary Gas Exchange,
Transport, and Delivery. In: Ayres SM, Grenvik A,
Holbrook PR, Shoemaker WC, editors. Textbook of
critical care. 3 rd ed. Philadelphia: WB Saunders; 1997.
p. 776-83.
19. West JB. Respiratory physiology – the essentials. Bal-
timore: The Williams & Wilkins Company; 1978. p.
116-28.
20. Tammeling GJ, Quanjer PH. Contours of breathing. 2.
Ingelheim am Rhein: Boehringer Ingelheim Interna-
tional GmbH, 1983. p. 195-243.
21. Rusconi F, Castagneto M, Gagliardi L. Reference values
for respiratory rate in the first 3 years of life. Pediatrics
1994; 94:350-5.
22. Darwis D. Analisis gas darah pada kegagalan pernapasan
akut. In: Hassan R, Kasim YA, Markum AH, editors.
Penatalaksanaan kegawatan pediatri. Jakarta: Fakultas
Kedokteran Universitas Indonesia; 1981. p. 47-56.
23. Nicholson JF, Pesce MA. Laboratory medicine and ref-
erence tables in infants and children. In: Behrman RE,
Kliegman RM, Nelson WE, editors. Nelson: Textbook
of Pediatrics. 12 th ed. Philadelphia: WB Saunders;
1992. p. 1797-827.
24. Swischuk LE, John SD. Differential diagnosis in pediat-
ric radiology. 2 nd ed. Baltimore: Williams & Wilkins;
1995. p. 64-82.
25. Kasim YA. Evaluasi neurologik anak dengan koma. Pre-
sented at the Simposium Pediatrik Gawat Darurat III:
Kedaruratan Saraf Anak; 1997 Nov 29; Bandung, In-
donesia.
26. Ontoseno T. Pemeriksaan klinis kardiovaskular
pada bayi dan anak. In: Putra ST, Advani N,
Rahayoe AU, editors. Dasar-dasar diagnosis dan
tatalaksana penyakit jantung pada anak. Jakarta:
Forum Ilmiah Kardiologi Anak Indonesia; 1996. p.
49-62.
27. Departemen Kesehatan RI. Pedoman tatalaksana
kekurangan energi protein pada anak di rumah sakit
kabupaten/kodya. Jakarta; 1998. lampiran 9.
28. Rab T. Prinsip gawat paru. 2 nd ed. Jakarta: EGC; 1996. p.
75-361.
29. Spooner V, Barker J, Tulloch S, Lehmann D, Marshall
TF, Kajoi M et al. Clinical signs and risk factors associ-
ated with pneumonia in children admitted to Goroka
Hospital, Papua New Guinea. J Trop Pediatr 1989;
35:295-300.
30. Margolis PA, Ferkol TW, Marsocci S, Super DM, Keyes
LL, McNutt R, et al. Accuracy of the clinical exami-
nation in detecting hypoxemia in infants with respira-
tory illness. J Pediatr 1994; 124:552-60.
Published
2016-09-26
How to Cite
1.
Gunawijaya E, Widia I. Clinical predictors of hypoxemia in pneumonia. PI [Internet]. 26Sep.2016 [cited 26Apr.2024];43(5):192-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/691
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Received 2016-09-24
Accepted 2016-09-24
Published 2016-09-26
Accepted 2016-09-24
Published 2016-09-26
