Importance US national guidelines discourage the use of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis who do not require supplemental oxygen. Objective Measure continuous pulse oximetry use in children with bronchiolitis. Design, Setting, and Participants A multicenter cross-sectional study was performed in pediatric wards in 56 US and Canadian hospitals in the Pediatric Research in Inpatient Settings Network from December 1, 2018, through March 31, 2019. Participants included a convenience sample of patients aged 8 weeks through 23 months with bronchiolitis who were not receiving active supplemental oxygen administration. Patients with extreme prematurity, cyanotic congenital heart disease, pulmonary hypertension, home respiratory support, neuromuscular disease, immunodeficiency, or cancer were excluded. Exposures Hospitalization with bronchiolitis without active supplemental oxygen administration. Main Outcomes and Measures The primary outcome, receipt of continuous pulse oximetry, was measured using direct observation. Continuous pulse oximetry use percentages were risk standardized using the following variables: nighttime (11 pm to 7 am), age combined with preterm birth, time after weaning from supplemental oxygen or flow, apnea or cyanosis during the present illness, neurologic impairment, and presence of an enteral feeding tube. Results The sample included 3612 patient observations in 33 freestanding children's hospitals, 14 children's hospitals within hospitals, and 9 community hospitals. In the sample, 59% were male, 56% were white, and 15% were black; 48% were aged 8 weeks through 5 months, 28% were aged 6 through 11 months, 16% were aged 12 through 17 months, and 9% were aged 18 through 23 months. The overall continuous pulse oximetry monitoring use percentage in these patients, none of whom were receiving any supplemental oxygen or nasal cannula flow, was 46% (95% CI, 40%-53%). Hospital-level unadjusted continuous pulse oximetry use ranged from 2% to 92%. After risk standardization, use ranged from 6% to 82%. Intraclass correlation coefficient suggested that 27% (95% CI, 19%-36%) of observed variation was attributable to unmeasured hospital-level factors. Conclusions and Relevance In a convenience sample of children hospitalized with bronchiolitis who were not receiving active supplemental oxygen administration, monitoring with continuous pulse oximetry was frequent and varied widely among hospitals. Because of the apparent absence of a guideline- or evidence-based indication for continuous monitoring in this population, this practice may represent overuse.

中文翻译：

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连续脉搏血氧饱和度监测在不需要补充氧气的毛细支气管炎住院儿童中的流行

重要性 美国国家指南不鼓励对不需要补充氧气的毛细支气管炎住院儿童使用连续脉搏血氧饱和度监测。目的 测量细支气管炎患儿的连续脉搏血氧饱和度。设计、环境和参与者 从 2018 年 12 月 1 日到 2019 年 3 月 31 日，在住院环境儿科研究网络的 56 家美国和加拿大医院的儿科病房中进行了一项多中心横断面研究。参与者包括方便的患者样本8 周至 23 个月患有细支气管炎且未接受主动补充氧气的患者。排除患有极端早产、紫绀型先天性心脏病、肺动脉高压、家庭呼吸支持、神经肌肉疾病、免疫缺陷或癌症的患者。暴露在没有主动补充氧气管理的毛细支气管炎住院治疗中。主要结果和测量主要结果，即接受连续脉搏血氧饱和度测定，使用直接观察进行测量。使用以下变量对连续脉搏血氧饱和度使用百分比进行风险标准化：夜间（晚上 11 点至早上 7 点）、年龄与早产相结合、从补充氧气或流量断奶后的时间、当前疾病期间的呼吸暂停或紫绀、神经功能障碍和存在肠内饲管。结果样本包括33家独立儿童医院、14家院内儿童医院和9家社区医院的3612名患者观察。在样本中，男性占 59%，白人占 56%，黑人占 15%；48% 的年龄在 8 周到 5 个月之间，28% 的年龄在 6 到 11 个月之间，16% 的年龄在 12 到 17 个月之间，9% 的年龄在 18 到 23 个月之间。这些患者的总体连续脉搏血氧饱和度监测使用百分比为 46%（95% CI，40%-53%），这些患者均未接受任何补充氧气或鼻导管流量。医院级未经调整的连续脉搏血氧饱和度使用范围从 2% 到 92%。风险标准化后，使用范围从 6% 到 82%。组内相关系数表明，27%（95% CI，19%-36%）的观察变异归因于未测量的医院层面因素。结论和相关性 在未接受主动补充氧气的毛细支气管炎住院儿童的便利样本中，连续脉搏血氧饱和度监测频繁且各医院差异很大。