Change from headbox to nasal cannula, an efficient oxygen therapy in toddlers with acute low respiratory tract infection

Abstract

Introduction: Oxygen (O₂) administration in toddlers who require it is performed mainly through a headbox, which produces a high cost in gas consumption in relation to nasal cannula. Hypothesis: The transition from headbox to nasal cannula will cause a decrease in oxygen flow around 1/3 or more needed to maintain an arterial oxygen saturation (Sat O₂), without significant variation in patients at the end-stage of a respiratory disease. 

Methods: Toddlers between 1 and 24 months-old at a stable phase of a respiratory infection, without any other concomitant disease and with an oxygen inspired fraction (FiO₂) £ 0,4 were admitted in the study. Headbox FiO₂, breath rate (BR), Sat O₂ and intercostal retraction were evaluated before and after the transition. A nasal cannula was used with a measured oxygen flow, being controlled and adjusted two hours later. Average, standard desviation, Mc Nemar’s X², and Student’s test were used to analyze the results.

Results: 41 patients were admitted to the study, with age 6.3 ± 4.7 months and weight 8.4 ± 3.1 kg. BR did not experiment significative changes and the required oxygen flow decreased from 7.0 to 1.1 l/min (p < 0.001). Clinical manifestations showed a positive response, with decrease in intercostal retraction on 14 children (p < 0.002). 

Conclusions: The hypothesis was verified. In stable patients with respiratory disease in resolution, the transition from headbox to nasal cannula implicated a decrease in oxygen flow of 5.9 l/min, representing 84,2% less used oxygen without changes in Sat O₂.