無需補充氧氣的毛細支氣管炎住院患兒持續脈搏血氧監測被過度使用
作者：
小柯機器人發布時間：2020/4/30 15:19:08
美國費城兒童醫院Christopher P. Bonafide聯合辛辛那提兒童醫院醫學中心Amanda Schondelmeyer課題組近期取得新進展。他們分析了無需補充氧氣的毛細支氣管炎住院患兒的連續脈搏血氧監測率。相關論文發表在2020年4月21日出版的《美國醫學會雜誌》上。
美國國家指南不建議在無需補充氧氣的毛細支氣管炎住院患兒中使用連續脈搏血氧飽和度監測。
為了衡量患有毛細支氣管炎的兒童的連續脈搏血氧飽和度監測，2018年12月1日至2019年3月31日，研究組在美國和加拿大56家醫院的兒科病房住院患者網絡中進行了一項多中心橫斷面研究，招募年齡為8周至23個月的毛細支氣管炎患兒，均未接受主動補充氧氣治療。
研究樣本包括33所獨立兒童醫院、14所醫院兒科和9所社區醫院的3612例患者的觀察結果。其中男性佔59％，白人佔56％，黑人佔15％；48％的年齡在8周至5個月內，28％的年齡在6至11個月內，16％的年齡在12至17個月內，9％的年齡在18至23個月內。
在這些沒有接受任何補充氧氣或鼻導管供氧的患兒中，總連續脈搏血氧飽和度監測使用率為46％。醫院水平的未經校正的連續脈搏血氧儀的使用範圍為2％至92％。風險標準化後，使用範圍為6％至82％。類內相關係數表明，27％的觀察差異歸因於無法衡量的醫院水平因素。
總之，在未接受主動補充氧氣治療的毛細支氣管炎住院兒童中，連續脈搏血氧飽和度監測經常使用，並且在各醫院之間差異很大。由於該人群中缺乏基於指南或證據的持續監測的適應症，因此血氧飽和度監測存在濫用情況。
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