Early weaning from oxygen therapy in African children with severe pneumonia
Abstract Background In Africa, severe pneumonia remains the major cause of paediatric hospitalisation, resulting in high requirements for oxygen therapy. Adequate supplies of oxygen are key challenges for many low-resource hospitals. The World Health Organization manual for oxygen therapy advises 2–...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12916-025-04178-9 |
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| author | Kathryn Maitland Elisa Giallongo Mainga Hamaluba Florence Alaroker Robert O. Opoka Abner Tagoola Damalie Nalwanga Eva Nabawanuka William Okiror Margaret Nakuya Denis Aromut Thomas N. Williams Karen Thomas David A. Harrison Paul Mouncey Andrew Bush J. F. Fraser Kathy Rowan Peter Olupot-Olupot Sarah Kiguli for the COAST trial group |
| author_facet | Kathryn Maitland Elisa Giallongo Mainga Hamaluba Florence Alaroker Robert O. Opoka Abner Tagoola Damalie Nalwanga Eva Nabawanuka William Okiror Margaret Nakuya Denis Aromut Thomas N. Williams Karen Thomas David A. Harrison Paul Mouncey Andrew Bush J. F. Fraser Kathy Rowan Peter Olupot-Olupot Sarah Kiguli for the COAST trial group |
| author_sort | Kathryn Maitland |
| collection | DOAJ |
| description | Abstract Background In Africa, severe pneumonia remains the major cause of paediatric hospitalisation, resulting in high requirements for oxygen therapy. Adequate supplies of oxygen are key challenges 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 (a) severe hypoxaemia (SpO2 < 80%) and (b) 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 h by pulse oximetry and weaned off oxygen once SpO2 > 92%. We describe the oxygen use and proportion requiring respiratory support over time by intervention strategy. Results Of the 1842 children enroled the majority, 1454 (79%) had moderate hypoxaemia. In this stratum, by 2 and 8 h, 148 (41%) and 200/360 (55.6%) in the LFO arm had been weaned; in the HFNT arm, 213/362 (59%) were receiving respiratory support at 2 h in room alone, and by 8 h, 164/362 (45%) had been weaned. At 48 h, 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 h 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 0 L (IQR 0.0) in the control arms. Children requiring oxygen beyond 48 h, 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 and 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. |
| format | Article |
| id | doaj-art-e2ba7d497bd84f4f83fcea36cef6a819 |
| institution | DOAJ |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Medicine |
| spelling | doaj-art-e2ba7d497bd84f4f83fcea36cef6a8192025-08-20T03:03:25ZengBMCBMC Medicine1741-70152025-07-0123111310.1186/s12916-025-04178-9Early weaning from oxygen therapy in African children with severe pneumoniaKathryn Maitland0Elisa Giallongo1Mainga Hamaluba2Florence Alaroker3Robert O. Opoka4Abner Tagoola5Damalie Nalwanga6Eva Nabawanuka7William Okiror8Margaret Nakuya9Denis Aromut10Thomas N. Williams11Karen Thomas12David A. Harrison13Paul Mouncey14Andrew Bush15J. F. Fraser16Kathy Rowan17Peter Olupot-Olupot18Sarah Kiguli19for the COAST trial groupDepartment Surgery and Cancer, Institute of Global Health Innovation, Imperial College LondonClinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC)Kenya Medical Research Institute (KEMRI) Wellcome Trust Research ProgrammeSoroti Regional Referral HospitalDepartment of Paediatrics, School of Medicine, Makerere University and Mulago HospitalJinja Regional Referral HospitalDepartment of Paediatrics, School of Medicine, Makerere University and Mulago HospitalDepartment of Paediatrics, School of Medicine, Makerere University and Mulago HospitalFaculty of Health Sciences, Busitema UniversitySoroti Regional Referral HospitalSoroti Regional Referral HospitalDepartment Surgery and Cancer, Institute of Global Health Innovation, Imperial College LondonClinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC)Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC)Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC)Imperial Centre for Paediatrics and Child Health, St Marys HospitalCritical Care Research Group and Intensive Care Service, University of Queenslandand, The Prince Charles Hospital Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC)Faculty of Health Sciences, Busitema UniversityDepartment of Paediatrics, School of Medicine, Makerere University and Mulago HospitalAbstract Background In Africa, severe pneumonia remains the major cause of paediatric hospitalisation, resulting in high requirements for oxygen therapy. Adequate supplies of oxygen are key challenges 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 (a) severe hypoxaemia (SpO2 < 80%) and (b) 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 h by pulse oximetry and weaned off oxygen once SpO2 > 92%. We describe the oxygen use and proportion requiring respiratory support over time by intervention strategy. Results Of the 1842 children enroled the majority, 1454 (79%) had moderate hypoxaemia. In this stratum, by 2 and 8 h, 148 (41%) and 200/360 (55.6%) in the LFO arm had been weaned; in the HFNT arm, 213/362 (59%) were receiving respiratory support at 2 h in room alone, and by 8 h, 164/362 (45%) had been weaned. At 48 h, 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 h 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 0 L (IQR 0.0) in the control arms. Children requiring oxygen beyond 48 h, 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 and 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.https://doi.org/10.1186/s12916-025-04178-9Severe pneumoniaAfrican childrenOxygen therapyHigh flow nasal therapy |
| spellingShingle | Kathryn Maitland Elisa Giallongo Mainga Hamaluba Florence Alaroker Robert O. Opoka Abner Tagoola Damalie Nalwanga Eva Nabawanuka William Okiror Margaret Nakuya Denis Aromut Thomas N. Williams Karen Thomas David A. Harrison Paul Mouncey Andrew Bush J. F. Fraser Kathy Rowan Peter Olupot-Olupot Sarah Kiguli for the COAST trial group Early weaning from oxygen therapy in African children with severe pneumonia BMC Medicine Severe pneumonia African children Oxygen therapy High flow nasal therapy |
| title | Early weaning from oxygen therapy in African children with severe pneumonia |
| title_full | Early weaning from oxygen therapy in African children with severe pneumonia |
| title_fullStr | Early weaning from oxygen therapy in African children with severe pneumonia |
| title_full_unstemmed | Early weaning from oxygen therapy in African children with severe pneumonia |
| title_short | Early weaning from oxygen therapy in African children with severe pneumonia |
| title_sort | early weaning from oxygen therapy in african children with severe pneumonia |
| topic | Severe pneumonia African children Oxygen therapy High flow nasal therapy |
| url | https://doi.org/10.1186/s12916-025-04178-9 |
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