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脉搏血氧饱和度(SpO2)监测在新生儿重症监护病房(NICU):提供者面临的挑战:系统评价。

Pulse Oximetry Saturation (Spo2) Monitoring in the Neonatal Intensive Care Unit (NICU): The Challenge for Providers: A Systematic Review.

机构信息

Neonatal Intensive Care Unit and Neonatology, "San Marco" Hospital, Azienda Ospedaliero Uniersitaria Policlinico "G. Rodolico -San Marco", Catania, Italy (Drs Falsaperla, Giacchi, Saporito, and Puglisi), and Unit of Clinical Pediatrics, Azienda Ospedaliero Uniersitaria Policlinico "G. Rodolico -San Marco", Catania, Italy (Dr Pavone), and Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Azienda Ospedaliero Uniersitaria Policlinico "G. Rodolico -San Marco", Catania, Italy (Dr Ruggieri).

出版信息

Adv Neonatal Care. 2022 Jun 1;22(3):231-238. doi: 10.1097/ANC.0000000000000914. Epub 2021 Jul 30.

Abstract

BACKGROUND

In the neonatal intensive care unit (NICU), maintaining an oxygenation level that avoids both hypoxemia and hyperoxemia is challenging. Pulse oximetry has become fundamental for noninvasive monitoring of saturation of peripheral oxygen (Spo2) in preterm newborns.

PURPOSE

The aim of this systematic review is to determine Spo2 target values in order to avoid hypoxemia or hyperoxemia and complications arising from these.

METHOD AND SEARCH STRATEGY

For this systematic review, articles were audited from 2010 to 2020 using the PRISMA guidelines. PubMed, MEDLINE, Google Scholar, and Scopus databases were used, and search terms were related to use of pulse oximetry in the NICU.

RESULTS

The result showed that 12 of 20 (60%) studies focused on target values but without a unanimous agreement on values, although 5 of 12 studies (41.66%) suggested a lower value target of 85% and 4 of 12 studies (33.33%) recommended 95% as the higher target value. Other authors showed no difference in the incidence of adverse events comparing different target values and focused the importance more on the fluctuation of the value than on the target value itself.

IMPLICATION FOR PRACTICE

Reaching a balance in the oxygen administration so as to avoid potential complications associated with hypoxemia or hyperoxemia is a challenge for the clinicians.

IMPLICATION FOR RESEARCH

Further studies on fluctuation of Spo2 comparing different starting targets could better clarify the role of fluctuations and the absolute target values.Video Abstract available at:https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=49.

摘要

背景

在新生儿重症监护病房(NICU)中,维持既不缺氧又不氧中毒的氧合水平具有挑战性。脉搏血氧饱和度仪已成为监测早产儿外周氧饱和度(SpO2)的非侵入性监测的基础。

目的

本系统评价的目的是确定 SpO2 目标值,以避免由此引起的缺氧或氧中毒及相关并发症。

方法和搜索策略

本系统评价使用 PRISMA 指南对 2010 年至 2020 年的文章进行了审核。使用了 PubMed、MEDLINE、Google Scholar 和 Scopus 数据库,并使用了与脉搏血氧饱和度仪在 NICU 中的使用相关的搜索词。

结果

结果显示,20 项研究中有 12 项(60%)重点关注目标值,但没有达成一致的意见,尽管有 5 项研究(41.66%)建议较低的目标值为 85%,4 项研究(33.33%)建议较高的目标值为 95%。其他作者在比较不同目标值时,发现不良事件的发生率没有差异,更关注值的波动,而不是目标值本身。

对实践的意义

为避免与缺氧或氧中毒相关的潜在并发症,在氧疗中达到平衡是临床医生面临的挑战。

对研究的意义

进一步研究不同起始目标的 SpO2 波动情况,可以更好地阐明波动和绝对目标值的作用。视频摘要可在以下网址获取:https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=49.

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