Schondelmeyer Amanda C, Dewan Maya L, Brady Patrick W, Timmons Kristen M, Cable Rhonda, Britto Maria T, Bonafide Christopher P
Divisions of Hospital Medicine,
James M. Anderson Center for Health Systems Excellence, and.
Pediatrics. 2020 Aug;146(2). doi: 10.1542/peds.2019-3336. Epub 2020 Jul 17.
Cardiorespiratory and pulse oximetry monitoring in children who are hospitalized should balance benefits of detecting deterioration with potential harms of alarm fatigue. We developed recommendations for monitoring outside the ICU on the basis of available evidence and expert opinion.
We conducted a comprehensive literature search for studies addressing the utility of cardiorespiratory and pulse oximetry monitoring in common pediatric conditions and drafted candidate monitoring recommendations based on our findings. We convened a panel of nominees from national professional organizations with diverse expertise: nursing, medicine, respiratory therapy, biomedical engineering, and family advocacy. Using the RAND/University of California, Los Angeles Appropriateness Method, panelists rated recommendations for appropriateness and necessity in 3 sequential rating sessions and a moderated meeting.
The panel evaluated 56 recommendations for intermittent and continuous monitoring for children hospitalized outside the ICU with 7 common conditions (eg, asthma, croup) and/or receiving common therapies (eg, supplemental oxygen, intravenous opioids). The panel reached agreement on the appropriateness of monitoring recommendations for 55 of 56 indications and on necessity of monitoring for 52. For mild or moderate asthma, croup, pneumonia, and bronchiolitis, the panel recommended intermittent vital sign or oximetry measurement only. The panel recommended continuous monitoring for severe disease in each respiratory condition as well as for a new or increased dose of intravenous opiate or benzodiazepine.
Expert panel members agreed that intermittent vital sign assessment, rather than continuous monitoring, is appropriate management for a set of specific conditions of mild or moderate severity that require hospitalization.
对住院儿童进行心肺和脉搏血氧饱和度监测时，应在检测病情恶化的益处与警报疲劳的潜在危害之间取得平衡。我们根据现有证据和专家意见制定了重症监护室外监测的建议。
我们对有关心肺和脉搏血氧饱和度监测在常见儿科疾病中的应用的研究进行了全面的文献检索，并根据研究结果起草了候选监测建议。我们召集了一个由来自国家专业组织的被提名者组成的小组，他们具有不同的专业知识：护理、医学、呼吸治疗、生物医学工程和家庭宣传。小组成员使用兰德公司/加利福尼亚大学洛杉矶分校适宜性方法，在3次连续的评分会议和一次有主持人的会议上对建议的适宜性和必要性进行评分。
该小组评估了56条关于对7种常见疾病（如哮喘、喉炎）住院的儿童和/或接受常见治疗（如补充氧气、静脉注射阿片类药物）的儿童进行间歇性和连续性监测的建议。该小组就56项适应症中的55项监测建议的适宜性以及52项监测的必要性达成了一致。对于轻度或中度哮喘、喉炎、肺炎和支气管炎，该小组仅建议间歇性测量生命体征或血氧饱和度。该小组建议对每种呼吸道疾病的重症以及新的或增加剂量的静脉注射阿片类药物或苯二氮卓类药物进行连续监测。
专家小组成员一致认为，对于一组需要住院治疗的轻度或中度特定病情，间歇性生命体征评估而非连续监测是合适的管理方式。
