Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2023 Nov;59(11):1223-1229. doi: 10.1111/jpc.16485. Epub 2023 Aug 31.
There is no evidence for how long bronchiolitis patients should be observed after coming off oxygen therapy and wide practice variation exists. We aimed to investigate whether it is safe to discharge bronchiolitis patients 4 h after cessation of oxygen therapy.
A retrospective single-centre cohort study of 884 infants (n = 462 in 2018 vs. n = 422 in 2019) aged 0-24 months admitted with bronchiolitis in 2018 and 2019 was conducted after implementation of a bronchiolitis protocol recommending discharge home 4 h post-cessation of oxygen therapy in 2019. We compared the rate of readmissions and Clinical Reviews/Rapid Responses in the pre- and post-exposure cohorts.
There was a significant reduction in median (interquartile range (IQR)) time to discharge post oxygen cessation by 87 min (510 (370-1033) min versus 423 (273-904) min; P < 0.001) and in median (IQR) length of stay by 6.7 h (2.11 (1.54-2.97) days vs. 1.83 (1.17-2.71) days; P < 0.001). There was no significant difference between readmissions in 2018 compared to 2019 (0.6% vs. 1.4%; P = 0.317). In 2018, there were two Clinical Reviews and in 2019 there were two Rapid Responses post-cessation of oxygen. There were 89 patients discharged within 4 h of cessation of oxygen therapy (n = 18 in 2018 vs. n = 71 in 2019; P < 0.001) with no readmissions, Clinical Reviews or Rapid Responses in the 2019 cohort.
This study demonstrates that patients can be discharged 4 h after cessation of supplemental oxygen without increased risk of adverse events.
目前尚无关于毛细支气管炎患者停止氧疗后应观察多长时间的证据，且实践中存在广泛的差异。本研究旨在探究停止氧疗 4 小时后是否可以安全地为毛细支气管炎患者办理出院。
本研究回顾性分析了 2018 年和 2019 年收治的 884 名 0-24 月龄毛细支气管炎患儿的单中心队列资料，其中 2018 年（n=462）患儿接受的是常规治疗，2019 年（n=422）患儿接受的是根据毛细支气管炎治疗方案进行治疗，该方案推荐在停止氧疗后 4 小时内为患儿办理出院。比较暴露前后两组患儿的再入院率和临床评估/快速反应率。
与 2018 年相比，停止氧疗后的中位（四分位数间距（IQR））时间减少了 87 分钟（510（370-1033）分钟 vs. 423（273-904）分钟；P<0.001），中位（IQR）住院时间减少了 6.7 小时（2.11（1.54-2.97）天 vs. 1.83（1.17-2.71）天；P<0.001）。2018 年与 2019 年再入院率无显著差异（0.6% vs. 1.4%；P=0.317）。2018 年有 2 次临床评估，2019 年有 2 次快速反应。2018 年有 18 例患者在停止氧疗后 4 小时内出院（n=18），2019 年有 71 例患者在停止氧疗后 4 小时内出院（n=71；P<0.001），两组均无再入院、临床评估或快速反应。
本研究表明，停止吸氧后 4 小时内为患者办理出院并不会增加不良事件的风险。
