Improving Pneumonia Management and Pulse Oximetry

2016 Pneumonia and Diarrhea Progress Report

Improving Pneumonia Management and Pulse Oximetry

Interview with Dr. Kim Mulholland, London, UK and Melbourne, AU

Successful Use of Pulse Oximetry Can Lead to Providing Lifesaving Therapies, Like Oxygen

Pulse oximeters, a small device that can measure the amount of oxygen in the blood without actually collecting any blood, have the potential to save many lives by identifying which children are seriously ill and in need of oxygen support. They aid in revealing hypoxemia, a crucial step in diagnosing severe pneumonia. But the technology is only useful if high-quality products are made available where most sick children seek care, and if health workers use them properly, explains pediatrician Kim Mulholland, MBBS, FRACP, MD, one of the original contributors to the development of the GAPPD. He has spent much of his distinguished career studying pneumonia management and prevention in low-income countries, particularly Sudan, Gambia, Fiji, Mongolia, and Vietnam.

Q: When it comes to pneumonia management, where is the gap?

A: My main concern is that in most developing countries, the district hospitals, where most children with pneumonia are managed, do not get the resources they need. They do not get adequate attention from the government resources, which tend to focus on supporting the teaching hospitals.

Q: How has the availability and quality of pulse oximetry changed over time?

A: In the last 10 years, pulse oximetry technology has improved and is more affordable. But the quality of pulse oximeters varies from brand to brand. For example, when I first started a pneumonia program in East Asia, I held training groups with doctors and most of them had a pulse oximeter in their pocket. But many of those being used were cheap and not well functioning. When I visited a few sick kids with some of the doctors, I came to the conclusion that their instruments were not working accurately. LifeBox® is a charity in the United Kingdom set up by the World Federation of Societies of Anesthesiologists. They are providing pulse oximeter sets for USD $250/unit to low-resource settings. The product has been tested extensively and it’s one of the most accurate. The LifeBox® also includes appropriate size probes for infants. This is a big step forward because it’s emphasizing the need for quality.

Q: How can appropriate use of pulse oximeters be improved?

A: Thorough training for health workers is necessary. There are times when the health worker puts the probe on the child’s finger when the child is screaming and wiggling. Maybe they get a bit of a signal on the monitor, 89% flashes a couple of times, and the health worker takes the probe off the child. Then they record the reading as 89%. Now that’s an inaccurate reading. Doing pulse oximetry on a very sick child is not trivial. It has to be done properly. You have to have a continuous signal, and you have to have a proper pulse picked up by the probe and appear on the monitor, before you can consider the pulse oximeter is providing an accurate reading of the oxygen in the blood.

Q: How can these lessons learned be applied to other pneumonia strategies?

A: Many of the challenges with pulse oximetry are shared by other simple, lifesaving tools and interventions, like vaccines, which may be much harder to put into practice in low-income settings. Continued work on access, quality and training will bridge the gap between strategies that we know work and putting them in action.

Kim Mulholland, MBBS, FRACP, MD, is a professor of child health and vaccinology at the London School of Hygiene and Tropical Medicine. Mulholland also holds professorial posts at Murdoch Children’s Research Institute in Melbourne and the Menzies School of Health Research in Darwin. In 2016, he published the first edition of the textbook, Pneumonia in Children: Epidemiology, Prevention and Treatment.