Use of Intermittent vs Continuous Pulse Oximetry for Nonhypoxemic Infants and Young Children Hospitalized for Bronchiolitis A Randomized Clinical Trial
Use of Intermittent vs Continuous Pulse Oximetry for Nonhypoxemic Infants and Young Children Hospitalized for Bronchiolitis A Randomized Clinical Trial
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DOI：
10.1001/jamapediatrics.2015.1746
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发表时间：
2015-10-01
期刊：
影响因子：
26.1
通讯作者：
Alverson, Brian
中科院分区：
文献类型：
--
作者：
McCulloh, Russell;Koster, Michael;Alverson, Brian
重要性 管理因细支气管炎住院的婴儿和儿童的临床实践指南建议仅对那些表现出临床改善的患者进行间歇性或“抽查”脉搏血氧饱和度读数。目前尚不清楚这种监测的效果。 目的 确定间歇性脉搏血氧饱和度监测与连续脉搏血氧饱和度监测对因细支气管炎住院的非低氧血症婴儿和幼儿住院时间的影响。 设计、设置和参与者 2009 年至 2014 年期间因细支气管炎住院的其他方面健康的婴儿和 2 岁或以下儿童的随机、平行组、优效性临床试验。美国有4家儿童医院。在获得知情同意之前，父母或监护人对分配分配一无所知；干预措施 住院期间，当氧饱和度水平达到 90% 或更高时，患者被随机分配接受连续或间歇性脉搏血氧饱和度监测（即，脉搏血氧饱和度测量与定期生命体征检查或临床怀疑病情恶化一起获得）。 主要结果和测量 住院时间是主要结果。次要结果指标包括补充氧气的使用持续时间和护理升级率（定义为转移到重症监护病房）。 结果 共有 449 名婴儿和幼儿接受了纳入筛查；排除了 288 名婴幼儿，最终纳入研究的患者为 161 名（80 名患者接受连续监测，81 名患者接受间歇性监测）。根据脉搏血氧饱和度监测策略，平均住院时间没有差异（连续监测为 48.9 小时 [95% CI，41.3-56.5 小时]，间歇监测为 46.2 小时 [95% CI，39.1-53.3 小时]；P = .77）。各组之间的护理升级率和补充氧气使用时间没有差异。结论和相关性对患有细支气管炎的非低氧血症患者进行间歇性脉搏血氧饱和度监测并没有缩短住院时间，并且与护理升级率或诊断或治疗措施的使用的任何差异无关。我们的结果表明，在治疗因细支气管炎住院且临床表现有所改善的婴儿和儿童时，可以常规考虑间歇性脉搏血氧饱和度监测。
IMPORTANCE Clinical practice guidelines for managing infants and children hospitalized for bronchiolitis recommend only obtaining intermittent or "spot check" pulse oximetry readings for those who show clinical improvement. The effect of such monitoring is currently unknown.OBJECTIVE To determine the effect of intermittent vs continuous pulse oximetry monitoring on hospital length of stay among nonhypoxemic infants and young children hospitalized for bronchiolitis.DESIGN, SETTING, AND PARTICIPANTS Randomized, parallel-group, superiority clinical trial of otherwise healthy infants and children 2 years of age or younger hospitalized for bronchiolitis during the period from 2009 to 2014 at 1 of 4 children's hospitals in the United States. Parents or guardians were blinded to allocation assignment until informed consent was obtained; study personnel and outcome assessors were not.INTERVENTIONS Patients were randomly assigned to undergo continuous or intermittent pulse oximetry monitoring (ie, pulse oximetry measurements were obtained along with a scheduled check of vital signs or for clinical suspicion of deterioration) during hospitalization when oxygen saturation levels were 90% or higher.MAIN OUTCOMES AND MEASURES Length of hospital stay was the primary outcome. Secondary outcome measures included duration of supplemental oxygen use and rate of escalation of care (defined as transfer to an intensive care unit).RESULTS A total of 449 infants and young children were screened for inclusion; 288 infants and young children were excluded, resulting in 161 patients who were enrolled in the study (80 patients underwent continuous monitoring, and 81 patients intermittent). The mean length of stay did not differ based on pulse oximetry monitoring strategy (48.9 hours [95% CI, 41.3-56.5 hours] for continuous monitoring vs 46.2 hours [95% CI, 39.1-53.3 hours] for intermittent monitoring; P = .77). The rates of escalation of care and duration of supplemental oxygen use did not differ between groups.CONCLUSIONS AND RELEVANCE Intermittent pulse oximetry monitoring of nonhypoxemic patients with bronchiolitis did not shorten hospital length of stay and was not associated with any difference in rate of escalation of care or use of diagnostic or therapeutic measures. Our results suggest that intermittent pulse oximetry monitoring can be routinely considered in the management of infants and children hospitalized for bronchiolitis who show clinical improvement.