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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. Aim: 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. [ABSTRACT FROM AUTHOR]

Comments on the focus of the American Academy of Pediatrics. Campaign of the academy to promote pediatrics and pediatricians; Benefits of the increase in the number of pediatricians; Concept of continuous, comprehensive personal care developed by most pediatricians.

Comments on the notion of well-child care and the reaction of U.S. pediatricians to it. Issues involved in the notion of well-child care; Reaction of the health insurance to the practice of well-child care by pediatricians; Necessity of creating a single authoritative source of standards for well-child care.