USE OF PULSE OXIMETRY IN THE HOSPITAL MANAGEMENT OF ACUTE ASTHMA IN CHILDHOOD

Oxyhemoglobin saturation values were recorded before and 10 minutes af ter 5 mg of nebulized salbutamol in 75 children (age, 1.5-14.6 years) admitted to hospital with acute asthma. Other assessments included hea rt rate, respiratory rate, peak expiratory flow rate, pulsus paradoxus , and an asthma severity score. All assessments were performed by the same observer (GC) and subsequent hospital care was transferred to the on-call pediatricians, who were not told the initial saturation value s. Six children required intravenous therapy after hospital admission when their symptoms were not improved after nebulized salbutamol. Cuto ff points for each continuous variable were selected so that they iden tified at least 5 of these 6 children (i.e., with a sensitivity of at least 83 percent). The resulting specificities and positive predictive values were calculated for each variable before and after nebulized t herapy. A postnebulizer saturation of less than 91% had a sensitivity of 100% [95% confidence interval (CI), (54-100] with a specificity of 98% (95% CI, 92-100) and a positive predictive value of 86%. This was the best predictor of the need for intravenous (IV) therapy. Correlati on coefficients were calculated for the 75 admissions and 2 others who required immediate IV treatment to determine how closely saturation v alues were related to the other recorded clinical variables. Saturatio n values were significantly, though weakly, correlated with asthma sev erity scores and prenebulizer heart rate, but they were not associated with any of the other variables. These results highlight the difficul ties encountered when assessing acute asthma in a hospital population with a large number of preschool children. Saturation measurements are easy to obtain in all age groups and help identify those children who require intensive therapy and close supervision after hospital admiss ion.