PT - JOURNAL ARTICLE AU - David Wertheim AU - Oana Anton AU - Catherine Olden AU - Sophie L V Le Maistre AU - Paul C Seddon TI - Pulse oximetry respiratory monitoring for assessment of acute childhood wheeze AID - 10.1136/archdischild-2021-323390 DP - 2022 Dec 01 TA - Archives of Disease in Childhood PG - 1083--1087 VI - 107 IP - 12 4099 - http://adc.bmj.com/content/107/12/1083.short 4100 - http://adc.bmj.com/content/107/12/1083.full SO - Arch Dis Child2022 Dec 01; 107 AB - Objective There is a lack of objective measures to assess children with acute wheezing episodes. Increased respiratory rate (RR) and pulsus paradoxus (PP) are recognised markers, but poorly recorded in practice. We examined whether they can be reliably assessed from a pulse oximeter plethysmogram (‘pleth’) trace and predict clinical outcome.Patients and methods We studied 44 children aged 1–7 years attending hospital with acute wheeze, following initial ‘burst’ bronchodilator therapy (BT), and used custom software to measure RR and assess PP from oximeter pleth traces. Traces were examined for quality, and the accuracy of the RR measurement was validated against simultaneous respiratory inductive plethysmography (RIP). RR and PP at 1 hour after BT were compared with clinical outcomes.Results RR from pleth and RIP showed excellent agreement, with a mean difference (RIP minus pleth) of −0.5 breaths per minute (limits of agreement −3.4 to +2.3). 52% of 1 min epochs contained 10 s or more of pleth artefact. At 1 hour after BT, children who subsequently required intravenous bronchodilators had significantly higher RR (median (IQR) 63 (62–66) vs 43 (37–51) breaths per minute) than those who did not, but their heart rate and oxygen saturation were similar. Children with RR ≥55 per minute spent longer in hospital: median (IQR) 30 (22–45) vs 10 (7–21) hours. All children who subsequently required hospital admission had PP-analogous pleth waveforms 1 hour after BT.Conclusion RR can be reliably measured and PP detected from the pulse oximeter pleth trace in children with acute wheeze and both markers predict clinical outcome.Trial registration number UKCRN15742.Data are available upon reasonable request.