Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, Little Rock, Arkansas.
Respir Care. 2021 Jul;66(7):1214-1223. doi: 10.4187/respcare.09006. Epub 2021 Mar 31.
Oxygen therapy is one of the most important therapeutics offered in the clinical management of pediatric patients with cardiopulmonary disease. As the medical community seeks to ensure evidence-based management of clinical interventions, we conducted a systematic review with the goal of providing evidence-based clinical practice guidelines to answer questions surrounding the use of simple oxygen therapy to improve oxygenation, including a comparison of delivery devices, the efficacy of humidification, comparison of flows, and goals for use in children. Using a modification of the RAND/UCLA Appropriateness Method, we developed 4 recommendations to assist clinicians in the utilization of oxygen therapy in hospitalized children: (1) the use of an oxygen hood or tent in lieu of a low-flow oxygen device for consistent oxygen delivery is not recommended; (2) the use of high-flow nasal cannula therapy is safe and more effective than low-flow oxygen to treat infants with moderate to severe bronchiolitis; (3) the application of humidification with low-flow oxygen delivery is not recommended; (4) targeting [Formula: see text] 90-97% for infants and children with bronchiolitis is recommended; however, no specific target can be recommended for pediatric patients with respiratory diseases outside of bronchiolitis, and establishing a patient/disease oxygen therapy target upon admission is considered best practice.
氧疗是心肺疾病儿科患者临床管理中最重要的治疗方法之一。随着医学界寻求确保基于证据的临床干预管理，我们进行了系统评价，旨在提供基于证据的临床实践指南，以回答有关使用简单氧疗来改善氧合的问题，包括比较输送设备、湿化的效果、比较流量以及在儿童中使用的目标。我们使用 RAND/UCLA 适宜性方法的修改版制定了 4 条建议，以帮助临床医生在住院儿童中使用氧疗：（1）不建议使用低流量氧气设备代替氧气罩或帐篷来进行持续氧气输送；（2）高流量鼻导管治疗在治疗中重度细支气管炎婴儿时是安全且更有效的，优于低流量氧气治疗；（3）不建议在低流量氧气输送时进行湿化；（4）对于患有细支气管炎的婴儿和儿童，建议将[Formula: see text]90-97%作为目标；然而，对于除细支气管炎以外的呼吸系统疾病的儿科患者，无法推荐特定的目标，并且在入院时为患者/疾病设定氧疗目标被认为是最佳实践。
