在孟加拉国低海拔地区，对健康儿童的脉搏血氧仪氧饱和度测量值定义低氧血症：一项观察性研究。
Defining hypoxaemia from pulse oximeter measurements of oxygen saturation in well children at low altitude in Bangladesh: an observational study.
机构信息
Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
出版信息
BMJ Open Respir Res. 2021 Nov;8(1). doi: 10.1136/bmjresp-2021-001023.
BACKGROUND
WHO defines hypoxaemia, a low peripheral arterial oxyhaemoglobin saturation (SpO), as <90%. Although hypoxaemia is an important risk factor for mortality of children with respiratory infections, the optimal SpO threshold for defining hypoxaemia is uncertain in low-income and middle-income countries (LMICs). We derived a SpO threshold for hypoxaemia from well children in Bangladesh residing at low altitude.
METHODS
We prospectively enrolled well, children aged 3-35 months participating in a pneumococcal vaccine evaluation in Sylhet district, Bangladesh between June and August 2017. Trained health workers conducting community surveillance measured the SpO of children using a Masimo Rad-5 pulse oximeter with a wrap sensor. We used standard summary statistics to evaluate the SpO distribution, including whether the distribution differed by age or sex. We considered the 2.5th, 5th and 10th percentiles of SpO as possible lower thresholds for hypoxaemia.
RESULTS
Our primary analytical sample included 1470 children (mean age 18.6±9.5 months). Median SpO was 98% (IQR 96%-99%), and the 2.5th, 5th and 10th percentile SpO was 91%, 92% and 94%. No child had a SpO <90%. Children 3-11 months had a lower median SpO (97%) than 12-23 months (98%) and 24-35 months (98%) (p=0.039). The SpO distribution did not differ by sex (p=0.959).
CONCLUSION
A SpO threshold for hypoxaemia derived from the 2.5th, 5th or 10th percentile of well children is higher than <90%. If a higher threshold than <90% is adopted into LMIC care algorithms then decision-making using SpO must also consider the child's clinical status to minimise misclassification of well children as hypoxaemic. Younger children in lower altitude LMICs may require a different threshold for hypoxaemia than older children. Evaluating the mortality risk of sick children using higher SpO thresholds for hypoxaemia is a key next step.
背景
世界卫生组织（WHO）将外周动脉血氧饱和度（SpO）低定义为<90%，即低氧血症。尽管低氧血症是儿童呼吸道感染死亡的重要危险因素，但在中低收入国家（LMICs），低氧血症的最佳 SpO 阈值尚不确定。我们从孟加拉国低海拔地区的健康儿童中得出了低氧血症的 SpO 阈值。
方法
我们前瞻性地招募了 2017 年 6 月至 8 月在孟加拉国锡尔赫特区参与肺炎球菌疫苗评估的 3-35 月龄健康儿童。进行社区监测的经过培训的卫生工作者使用带有包裹式传感器的 Masimo Rad-5 脉搏血氧仪测量儿童的 SpO。我们使用标准汇总统计数据评估 SpO 分布，包括该分布是否因年龄或性别而异。我们考虑 SpO 的第 2.5、5 和 10 百分位数作为低氧血症的可能较低阈值。
结果
我们的主要分析样本包括 1470 名儿童（平均年龄 18.6±9.5 个月）。中位数 SpO 为 98%（IQR 96%-99%），第 2.5、5 和 10 百分位数 SpO 分别为 91%、92%和 94%。没有儿童的 SpO<90%。3-11 月龄儿童的中位 SpO（97%）低于 12-23 月龄（98%）和 24-35 月龄（98%）（p=0.039）。SpO 分布与性别无关（p=0.959）。
结论
从健康儿童的第 2.5、5 或 10 百分位数得出的低氧血症 SpO 阈值高于<90%。如果将低于<90%的阈值应用于 LMIC 护理算法，那么使用 SpO 进行决策时还必须考虑儿童的临床状况，以尽量减少将健康儿童误诊为低氧血症。低海拔 LMICs 中的年幼儿童可能需要比年长儿童更高的低氧血症阈值。使用较低的低氧血症 SpO 阈值评估患病儿童的死亡风险是下一步的关键。
Zotero 插件