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Article Reviews and Commentary

The Efficacy of Noncontact Oxygen Delivery Methods.
Davies PD, Cheung D, Fox AF et al. Pediatrics 2002;110:964-967

The authors sought to quantitate the Fi0₂ actually administered to patients with so-called "blow-by" oxygen delivery. Three different methods of oxygen delivery were studied: an infant resuscitator bag, a standard pediatric facemask and a piece of green oxygen tubing. Flow rates of 5 L/min and 10 L/min were used and oxygen concentration measured in 10% increments using a Teledyne oxygen meter. Contour lines of oxygen concentration were constructed for each of the three delivery methods

The authors found that the resuscitator bag was unsatisfactory because the flow-back valve may close. Oxygen tubing gave 30% oxygen concentration to an area approximately only18 cm wide, while the face mask. The pediatric face mask, at a flow rate of 10 L/min gave a 30% concentration of oxygen to an area approximately 30 cm x 30 cm. Forty percent oxygen is delivered to an area approximately 15 cm x 15 cm using that same 10 L/min flow rate with a pediatric face mask,

The authors conclude that while these methods of oxygen delivery certainly cannot replace conventional means currently used, noncontact methods may have uses in certain situations. They recommend noncontact methods of oxygen administration for short-term administration certain selected situations.

Commentary Thomas J. Mancuso, MD, FAAP

Often children are intolerant of intrusive methods of oxygen administration in the PACU of in transport from the OR to the PACU. This paper nicely demonstrates that it is possible to provide 30% to 40% to children with "blow-by" or the author's term "wafting" administration. An important contribution is the clarification of the flow rates and delivery methods needed to achieve 30%-40% oxygen concentration in an area near a patients face.

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