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Oximetry-detected pulsus paradoxus predicts for severity in paediatric asthma
  1. Sandhya G Krishnan1,
  2. Hung Chew Wong2,
  3. Sashikumar Ganapathy3,
  4. Gene Yong-Kwang Ong3
  1. 1Department of Paediatric Medicine, KK Women's and Children’s Hospital, Singapore, Singapore
  2. 2Research Support Unit, Dean’s Office, Yong Loo Lin School of Medicine, National University Health System, Faculty of Medicine, National University of Singapore, Singapore, Singapore
  3. 3Department of Emergency Medicine, KK Women's and Children’s Hospital, Singapore, Singapore
  1. Correspondence to Dr Sandhya G Krishnan, Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore 229899, Singapore; sandhya.gkrishnan{at}mohh.com.sg

Abstract

Objective To evaluate if qualitative visual detection of pulsus paradoxus (PP) on the pulse oximeter plethysmograph can predict outcomes for children with moderate to severe respiratory distress in a paediatric emergency department (ED).

Design Prospective cohort study.

Setting Paediatric ED of a tertiary paediatrics hospital in Singapore.

Patients Children managed for moderate to severe wheezing in the resuscitation bay of the ED.

Interventions Patients were assessed for the presence of PP based on visual detection of oximeter plethysmograph before and after initial inhaled bronchodilator therapy.

Main outcome measures These include the need for adjunct medications such as aminophylline or magnesium sulfate, the need for supplementary ventilation and the need for admission to the high dependency unit (HDU) or intensive care unit (ICU).

Results There were 285 patients included in the study, of whom 78 (27.4%) had PP at ED presentation. There were 40 (14.0%) who had PP after initial management. Children who had PP after initial management had significantly relative risks (RR) of requiring adjunct medications (RR 12.5, 95% CI 4.0 to 38.6), need for supplementary ventilation (RR 5.6, 95% CI 1.2 to 26.5) and admission to the HDU/ICU (RR 5.6, 95% CI 3.0 to 10.4).

Conclusion Qualitative detection of PP on pulse oximetry can be used as a potential point-of-care tool to help in the assessment of response to initial treatment in paediatric patients with acute moderate to severe asthma exacerbations. Future studies are needed to assess and validate its role in guiding ED management of acute paediatric asthma.

  • asthma
  • accident & emergency
  • general paediatrics
  • respiratory
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Footnotes

  • Contributors SGK contributed substantially in the methodological design, collecting the data, interpretation of the data, drafting the work and agreeing to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. She approves of the final version to be published. HCW helped in analysis and interpretation of data for the work, revising the work critically for important intellectual content and in approving the final version to be published. She agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. She approves of the final version to be published. SG contributed substantially in the methodological design, collecting the data, interpretation of the data, the analysis and interpretation of data for the work, revising the manuscript critically for important intellectual content and in approval of the final version to be published. He agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. He approves of the final version to be published. GY-KO conceived the presented idea, substantially contributed to the methodological design, analysis and interpretation of data for the work, revising the manuscript critically for important intellectual content and in approval of the final version to be published. He agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. He approves of the final version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Approval was obtained from the local SingHealth Centralised Institutional Review Board (CIRB) prior to commencement of the study. The CIRB approval number is 2014/091/E.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The corresponding author (Sandhya G Krishnan, sandhya.gkrishnan@mohh.com.sg) has stored the deidentified patient data in a password-locked desktop computer and can provide the data on request.

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