title: A model for oxygen conservation associated with titration during pediatric oxygen therapy.
abstract: BACKGROUND
  Continuous oxygen treatment is essential for managing children with hypoxemia, but access to oxygen in low-resource countries remains problematic. Given the high burden of pneumonia in these countries and the fact that flow can be gradually reduced as therapy progresses, oxygen conservation through routine titration warrants exploration.
  
  
  OBJECTIVE
  To determine the amount of oxygen saved via titration during oxygen therapy for children with hypoxemic pneumonia.
  
  
  METHODS
  Based on published clinical data, we developed a model of oxygen flow rates needed to manage hypoxemia, assuming recommended flow rate at start of therapy, and comparing total oxygen used with routine titration every 3 minutes or once every 24 hours versus no titration.
  
  
  RESULTS
  Titration every 3 minutes or every 24 hours provided oxygen savings estimated at 11.7% ± 5.1% and 8.1% ± 5.1% (average ± standard error of the mean, n = 3), respectively. For every 100 patients, 44 or 30 kiloliters would be saved-equivalent to 733 or 500 hours at 1 liter per minute.
  
  
  CONCLUSIONS
  Ongoing titration can conserve oxygen, even performed once-daily. While clinical validation is necessary, these findings could provide incentive for the routine use of pulse oximeters for patient management, as well as further development of automated systems.
authors.affiliation: Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America.|Consultant for PATH, Seattle, Washington, United States of America.
authors.forename: Grace
authors.initials: G
authors.lastname: Wu
authors.affiliation: PATH, Seattle, Washington, United States of America.
authors.forename: Alec
authors.initials: A
authors.lastname: Wollen
authors.affiliation: Consultant for PATH, Seattle, Washington, United States of America.
authors.forename: Stephen
authors.initials: S
authors.lastname: Himley
authors.affiliation: PATH, Seattle, Washington, United States of America.
authors.forename: Glenn
authors.initials: G
authors.lastname: Austin
authors.affiliation: PATH, Seattle, Washington, United States of America.
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Delarosa
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.
authors.forename: Rasa
authors.initials: R
authors.lastname: Izadnegahdar
authors.affiliation: Save the Children, Fairfield, Connecticut, United States of America.
authors.forename: Amy Sarah
authors.initials: AS
authors.lastname: Ginsburg
authors.affiliation: PATH, Seattle, Washington, United States of America.
authors.forename: Darin
authors.initials: D
authors.lastname: Zehrung
mesh_terms: D002675:Child, Preschool; D003906:Developing Countries; D006801:Humans; D000860:Hypoxia / Q000191:economics* / Q000503:physiopathology / Q000628:therapy; D007223:Infant; D015233:Models, Statistical; D010092:Oximetry / Q000295:instrumentation / Q000379:methods; D010100:Oxygen / Q000032:analysis* / Q000191:economics / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D011014:Pneumonia / Q000191:economics* / Q000503:physiopathology / Q000628:therapy
chemical_list: D010100:Oxygen