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无需补充氧气的毛细支气管炎住院患儿持续脉搏
2020-05-01 13:40

本期文章:《美国医学会杂志》:Vol 323 No 15

美国费城儿童医院Christopher P. Bonafide联合辛辛那提儿童医院医学中心Amanda Schondelmeyer课题组近期取得新进展。他们分析了无需补充氧气的毛细支气管炎住院患儿的连续脉搏血氧监测率。相关论文发表在2020年4月21日出版的《美国医学会杂志》上。

美国国家指南不建议在无需补充氧气的毛细支气管炎住院患儿中使用连续脉搏血氧饱和度监测。

为了衡量患有毛细支气管炎的儿童的连续脉搏血氧饱和度监测,2018年12月1日至2019年3月31日,研究组在美国和加拿大56家医院的儿科病房住院患者网络中进行了一项多中心横断面研究,招募年龄为8周至23个月的毛细支气管炎患儿,均未接受主动补充氧气治疗。

研究样本包括33所独立儿童医院、14所医院儿科和9所社区医院的3612例患者的观察结果。其中男性占59%,白人占56%,黑人占15%;48%的年龄在8周至5个月内,28%的年龄在6至11个月内,16%的年龄在12至17个月内,9%的年龄在18至23个月内。

在这些没有接受任何补充氧气或鼻导管供氧的患儿中,总连续脉搏血氧饱和度监测使用率为46%。医院水平的未经校正的连续脉搏血氧仪的使用范围为2%至92%。风险标准化后,使用范围为6%至82%。类内相关系数表明,27%的观察差异归因于无法衡量的医院水平因素。

总之,在未接受主动补充氧气治疗的毛细支气管炎住院儿童中,连续脉搏血氧饱和度监测经常使用,并且在各医院之间差异很大。由于该人群中缺乏基于指南或证据的持续监测的适应症,因此血氧饱和度监测存在滥用情况。

附:英文原文

Title: Prevalence of Continuous Pulse Oximetry Monitoring in Hospitalized Children With Bronchiolitis Not Requiring Supplemental Oxygen

Author: Christopher P. Bonafide, Rui Xiao, Patrick W. Brady, Christopher P. Landrigan, Canita Brent, Courtney Benjamin Wolk, Amanda P. Bettencourt, Lisa McLeod, Frances Barg, Rinad S. Beidas, Amanda Schondelmeyer

Issue&Volume: 2020/04/21

Abstract: Importance  US national guidelines discourage the use of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis who do not require supplemental oxygen.

Objective  Measure continuous pulse oximetry use in children with bronchiolitis.

Design, Setting, and Participants  A multicenter cross-sectional study was performed in pediatric wards in 56 US and Canadian hospitals in the Pediatric Research in Inpatient Settings Network from December 1, 2018, through March 31, 2019. Participants included a convenience sample of patients aged 8 weeks through 23 months with bronchiolitis who were not receiving active supplemental oxygen administration. Patients with extreme prematurity, cyanotic congenital heart disease, pulmonary hypertension, home respiratory support, neuromuscular disease, immunodeficiency, or cancer were excluded.

Exposures  Hospitalization with bronchiolitis without active supplemental oxygen administration.

Main Outcomes and Measures  The primary outcome, receipt of continuous pulse oximetry, was measured using direct observation. Continuous pulse oximetry use percentages were risk standardized using the following variables: nighttime (11 pm to 7 am), age combined with preterm birth, time after weaning from supplemental oxygen or flow, apnea or cyanosis during the present illness, neurologic impairment, and presence of an enteral feeding tube.

Results  The sample included 3612 patient observations in 33 freestanding children's hospitals, 14 children's hospitals within hospitals, and 9 community hospitals. In the sample, 59% were male, 56% were white, and 15% were black; 48% were aged 8 weeks through 5 months, 28% were aged 6 through 11 months, 16% were aged 12 through 17 months, and 9% were aged 18 through 23 months. The overall continuous pulse oximetry monitoring use percentage in these patients, none of whom were receiving any supplemental oxygen or nasal cannula flow, was 46% (95% CI, 40%-53%). Hospital-level unadjusted continuous pulse oximetry use ranged from 2% to 92%. After risk standardization, use ranged from 6% to 82%. Intraclass correlation coefficient suggested that 27% (95% CI, 19%-36%) of observed variation was attributable to unmeasured hospital-level factors.

Conclusions and Relevance  In a convenience sample of children hospitalized with bronchiolitis who were not receiving active supplemental oxygen administration, monitoring with continuous pulse oximetry was frequent and varied widely among hospitals. Because of the apparent absence of a guideline- or evidence-based indication for continuous monitoring in this population, this practice may represent overuse.

DOI: 10.1001/jama.2020.2998

Source: https://jamanetwork.com/journals/jama/article-abstract/2764708

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