Intermittent vs Continuous Pulse Oximetry in Hospitalized Infants With Stabilized Bronchiolitis A Randomized Clinical Trial
Intermittent vs Continuous Pulse Oximetry in Hospitalized Infants With Stabilized Bronchiolitis A Randomized Clinical Trial
复制标题
DOI：
10.1001/jamapediatrics.2020.6141
复制
发表时间：
2021-03-01
期刊：
影响因子：
26.1
通讯作者：
Parkin, Patricia C.
中科院分区：
文献类型：
--
作者：
Mahant, Sanjay;Wahi, Gita;Parkin, Patricia C.
重要性有低水平的证据和实质性的实践变化，关于使用间歇或连续监测在婴儿住院与bronchiolitis.OBJECTIVE比较的影响，间歇与连续脉搏血氧饱和度对临床outcome.DESIGN，设置，和参与者这一多中心，务实的随机临床试验包括婴儿4周至24个月的年龄谁是住院与bronchiolitis. DESIGN，设置，和PARTICIPANTS，2016年至2019年5月31日，在加拿大安大略的社区和儿童医院稳定后，有或没有补充氧气。干预（每4小时，n = 114）或连续（n = 115）脉搏血氧测定，使用90%的氧饱和度目标主要结果和测量主要结果是从随机分组到出院的住院时间长度。次要结局包括从住院单位入院到出院的住院时间和随机化测量的结局：医疗干预、安全性（重症监护室转移和复诊）、父母焦虑和缺勤天数、护理满意度（中位[IQR]年龄，4.0 [2.2-8.5]个月; 136 [59.4%]男性; 101例[44.1%]来自社区医院研究中心），从随机化至出院的中位住院时间为27.6小时（四分位数间距[IQR]，18.8-49.6小时），连续组为25.4小时（IQR，18.3-47.6小时）（中位数差异，2.2小时; 95%CI，-1.9至6.3小时; P = 0.17）。间歇组和连续组之间从住院到出院的中位住院时间无显著差异：49.1（IQR，37.2-87.0）小时vs 46.0（IQR，32.5-73.8）小时（P = .13）或医院干预的频率或持续时间，如开始补充氧气：4/114（3.5%）vs. 9/115（7.8%）（P = 0.16），中位吸氧持续时间：20.6（IQR，7.6-46.1）小时vs. 21.4（11.6-52.9）小时（P = 0.66）。同样，重症监护室转移的频率也没有显著差异：114例中有1例（0.9%）vs 2/115（百分之二点七）（P = .76）;再次入院：3/114（2.6%），间歇性组为4/115（3.5%）连续组（P > .99）;父母焦虑：平均（SD）父母焦虑评分，2.9间歇性组为0.9，（0.9）在连续组（P = 0.40）;或父母的工作日错过：中位数工作日错过，1.5（IQR，0.5-3.0）比1.5（IQR，0.5-2.5）（P = 0.36）。间歇性组对监测的平均（SD）护理满意度显著更高：8.6（1.7）vs 7.1（2.8）10个工作日;平均差异为1.5（95%可信区间，0.9-2.2; P < .001）。结论和相关性在这项随机临床试验中，在患有稳定的毛细支气管炎伴或不伴缺氧并使用90%或更高的氧饱和度目标进行管理的婴儿中，临床结局，包括住院时间和安全性，间歇性与连续性脉搏血氧饱和度测定相似。间歇性监测的护理满意度更高。考虑到其他重要的临床实践考虑因素倾向于不太强烈的监测，这些发现支持在因细支气管炎住院的稳定婴儿中标准使用间歇性脉搏血氧饱和度。
IMPORTANCE There is low level of evidence and substantial practice variation regarding the use of intermittent or continuous monitoring in infants hospitalized with bronchiolitis.OBJECTIVE To compare the effect of intermittent vs continuous pulse oximetry on clinical outcomes.DESIGN, SETTING, AND PARTICIPANTS This multicenter, pragmatic randomized clinical trial included infants 4 weeks to 24 months of age who were hospitalized with bronchiolitis from November 1, 2016, to May 31, 2019, with or without supplemental oxygen after stabilization at community and children's hospitals in Ontario, Canada.INTERVENTIONS Intermittent (every 4 hours, n = 114) or continuous (n = 115) pulse oximetry, using an oxygen saturation target of 90% or higher.MAIN OUTCOMES AND MEASURES The primary outcome was length of hospital stay from randomization to discharge. Secondary outcomes included length of stay from inpatient unit admission to discharge and outcomes measured from randomization: medical interventions, safety (intensive care unit transfer and revisits), parent anxiety and workdays missed, and nursing satisfaction.RESULTS Among 229 infants enrolled (median [IQR] age, 4.0 [2.2-8.5] months; 136 [59.4%] male; 101 [44.1%] from community hospital sites), the median length of hospital stay from randomization to discharge was 27.6 hours (interquartile range [IQR], 18.8-49.6 hours) in the intermittent group and 25.4 hours (IQR, 18.3-47.6 hours) in the continuous group (difference of medians, 2.2 hours; 95% CI, -1.9 to 6.3 hours; P = .17). No significant differences were observed between the intermittent and continuous groups in the median length of stay from inpatient unit admission to discharge: 49.1 (IQR, 37.2-87.0) hours vs 46.0 (IQR, 32.5-73.8) hours (P = .13) or in frequencies or durations of hospital interventions, such as oxygen supplementation initiation: 4 of 114 (3.5%) vs. 9 of 115 (7.8%) (P = .16) and median duration of oxygen supplementation: 20.6 (IQR, 7.6-46.1) hours vs. 21.4 (11.6-52.9) hours (P = .66). Similarly, there were no significant differences in frequencies of intensive care unit transfer: 1 of 114 (0.9%) vs 2 of 115 (2.7%) (P = .76); readmission to hospital: 3 of 114 (2.6%) in the intermittent group vs 4 of 115 (3.5%) in the continuous group (P > .99); parent anxiety: mean (SD) parent anxiety score, 2.9 (0.9) in the intermittent group vs 2.8 (0.9) in the continuous group (P = .40); or parent workdays missed: median workdays missed, 1.5 (IQR, 0.5-3.0) vs 1.5 (IQR, 0.5-2.5) (P = .36). Mean (SD) nursing satisfaction with monitoring was significantly greater in the intermittent group: 8.6 (1.7) vs 7.1 (2.8) of 10 workdays; the mean difference was 1.5 (95% CI, 0.9-2.2; P < .001).CONCLUSIONS AND RELEVANCE In this randomized clinical trial, among infants hospitalized with stabilized bronchiolitis with and without hypoxia and managed using an oxygen saturation target of 90% or higher, clinical outcomes, including length of hospital stay and safety, were similar with intermittent vs continuous pulse oximetry. Nursing satisfaction was greater with intermittent monitoring. Given that other important clinical practice considerations favor less intense monitoring, these findings support the standard use of intermittent pulse oximetry in stable infants hospitalized with bronchiolitis.