Early weaning from oxygen therapy in African children with severe pneumonia
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Author(s)
Type
Journal Article
Abstract
Background:
In Africa severe pneumonia is the major cause of paediatric hospital admission, resulting in high
requirements for oxygen therapy. Adequate supplies of oxygen remain a major challenge for many
low-resource hospitals. The World Health Organization manual for oxygen therapy advises 2-3
days of oxygen therapy for pneumonia and recommends against early weaning, even in the
absence of hypoxaemia. Few data support this recommendation. We describe the oxygen use and
timing of weaning in the COAST trial of oxygen therapy (ISRCTN15622505).
Methods:
Children aged 28 days to 12 years presenting to 6 hospitals in Uganda and Kenya with severe
pneumonia and hypoxaemia (saturations < 92% on pulse oximetry (SpO2) were eligible for the
trial. Children in two strata – (1) severe hypoxaemia (SpO2<80%) and (2) moderate hypoxaemia
(SpO2 80-91%) -were allocated to receive high flow nasal therapy (HFNT), low flow oxygen delivery
(LFO) or control (no immediate oxygen (moderate hypoxaemia stratum only)). Children were
closely monitored over 48 hours by pulse oximetry and weaned off oxygen once SpO2>92%. We
describe the oxygen use and proportion requiring respiratory support overtime by intervention
strategy.
Results:
Of the 1842 children enrolled the majority 1454 (79%) had moderate hypoxaemia. In this stratum
by 2- and 8-hours 148 (41%) and 200/360 (55.6%) in the LFO arm been weaned; in the HFNT arm
213/362 (59%) were receiving respiratory support at 2 hours in room alone and by in the 8 hours
164/362 (45%) had been weaned. At 48 hours in the respective strata 77-80% and 53-63% still had
respiratory distress but without hypoxaemia and were thus not receiving oxygen. Median oxygen
use at 48 hours in the moderate hypoxaemia group was highest in LFO am 480L (IQR 236.2, 2132.2)]
compared to 113.4 L(IQR 0.0, 1453.9) in the HFNT and 0L (IQR 0,0) i in the control arms. Children
requiring oxygen beyond 48 hours, 17/33 (51.1%) and 9/46 (19.5%) in the respective strata had
additional cardiac conditions.
Conclusions:
Closely monitoring SpO2 resulted in early weaning reduced the use of and exposure to oxygen.
Where oxygen supplies are at a premium, this approach may improve equitable access for children
with severe pneumonia.
In Africa severe pneumonia is the major cause of paediatric hospital admission, resulting in high
requirements for oxygen therapy. Adequate supplies of oxygen remain a major challenge for many
low-resource hospitals. The World Health Organization manual for oxygen therapy advises 2-3
days of oxygen therapy for pneumonia and recommends against early weaning, even in the
absence of hypoxaemia. Few data support this recommendation. We describe the oxygen use and
timing of weaning in the COAST trial of oxygen therapy (ISRCTN15622505).
Methods:
Children aged 28 days to 12 years presenting to 6 hospitals in Uganda and Kenya with severe
pneumonia and hypoxaemia (saturations < 92% on pulse oximetry (SpO2) were eligible for the
trial. Children in two strata – (1) severe hypoxaemia (SpO2<80%) and (2) moderate hypoxaemia
(SpO2 80-91%) -were allocated to receive high flow nasal therapy (HFNT), low flow oxygen delivery
(LFO) or control (no immediate oxygen (moderate hypoxaemia stratum only)). Children were
closely monitored over 48 hours by pulse oximetry and weaned off oxygen once SpO2>92%. We
describe the oxygen use and proportion requiring respiratory support overtime by intervention
strategy.
Results:
Of the 1842 children enrolled the majority 1454 (79%) had moderate hypoxaemia. In this stratum
by 2- and 8-hours 148 (41%) and 200/360 (55.6%) in the LFO arm been weaned; in the HFNT arm
213/362 (59%) were receiving respiratory support at 2 hours in room alone and by in the 8 hours
164/362 (45%) had been weaned. At 48 hours in the respective strata 77-80% and 53-63% still had
respiratory distress but without hypoxaemia and were thus not receiving oxygen. Median oxygen
use at 48 hours in the moderate hypoxaemia group was highest in LFO am 480L (IQR 236.2, 2132.2)]
compared to 113.4 L(IQR 0.0, 1453.9) in the HFNT and 0L (IQR 0,0) i in the control arms. Children
requiring oxygen beyond 48 hours, 17/33 (51.1%) and 9/46 (19.5%) in the respective strata had
additional cardiac conditions.
Conclusions:
Closely monitoring SpO2 resulted in early weaning reduced the use of and exposure to oxygen.
Where oxygen supplies are at a premium, this approach may improve equitable access for children
with severe pneumonia.
Date Issued
2025-07-01
Date Acceptance
2025-06-02
Citation
BMC Medicine, 2025, 23
ISSN
1741-7015
Publisher
BMC
Journal / Book Title
BMC Medicine
Volume
23
Copyright Statement
© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s12916-025-04178-9
Publication Status
Published
Article Number
366