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

不需要补充氧气的毛细支气管炎住院患儿持续脉搏血氧监测的患病率。

  • 影响因子:6.98
  • DOI:10.1001/jama.2020.2998
  • 作者列表:"Bonafide CP","Xiao R","Brady PW","Landrigan CP","Brent C","Wolk CB","Bettencourt AP","McLeod L","Barg F","Beidas RS","Schondelmeyer A","Pediatric Research in Inpatient Settings (PRIS) Network.
  • 发表时间: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.

摘要

重要性: 美国国家指南不鼓励在不需要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。 目的: 测定小儿毛细支气管炎持续脉搏血氧饱和度的变化。 设计、地点和参与者: 20 1 8 年 12 月 1 日在儿科研究住院设置网络中 56 家美国和加拿大医院的儿科病房进行了一项多中心横断面研究,通过 3 月 1 日,20 1 9。参与者包括 8 周至 23 个月的毛细支气管炎患者的便利样本,这些患者没有接受活性补充氧给药。排除极度早产、紫otic型先天性心脏病、肺动脉高压、家庭呼吸支持、神经肌肉疾病、免疫缺陷或癌症患者。 暴露: 毛细支气管炎住院,无主动补充氧给药。 主要结局和措施: 主要结局,接受连续脉搏血氧饱和度测定,使用直接观察进行测量。使用以下变量对连续脉搏血氧饱和度使用百分比进行风险标准化: 夜间 (下午11点至上午7点) 、年龄合并早产、从补充氧气或流量断奶后的时间,目前疾病期间的呼吸暂停或发绀、神经功能缺损和肠内营养管的存在。 结果: 样本包括 33 家独立式儿童医院、 14 家医院内的儿童医院和 9 家社区医院的 3612 例患者观察。在样本中,5 9% 为男性,5 6% 为白人,1 5% 为黑人; 48% 为 8 周至 5 个月的年龄,28% 为 6 至 11 个月的年龄,16% 的年龄为 12 至 17 个月,9% 的年龄为 18 至 23 个月。这些患者的总体连续脉搏血氧饱和度监测使用百分比为 46% (95% CI,40%-53%),这些患者均未接受任何补充氧气或鼻导管流量。医院水平未调整的连续脉搏血氧饱和度使用范围为 2% ~ 92%。风险标准化后,使用范围为 6%-82%。组内相关系数表明,27% (95% CI,19%-36%) 的观察到的变异归因于未测量的医院水平因素。 结论和相关性: 在未接受积极补充氧气给药的毛细支气管炎住院患儿的便利样本中,连续脉搏血氧饱和度监测频繁,医院间差异很大。由于在该人群中明显缺乏连续监测的指南或循证指征,这种做法可能代表过度使用。

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呼吸道感染方向

呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。

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