Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis

Hendaus, Mohamed A.; Nassar, Suzan; Leghrouz, Bassil; Alhammadi, Ahmed H; Alamri, Mohammed S.

doi:10.2147/ppa.s152880

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…[24-26] Hendaus et al showed that approximately 85% of caregivers feel safe monitoring with continuous pulse oximetry in children with bronchiolitis. [27] Similar kinds of literature related to bronchiolitis demonstrate the practice of monitoring without guidelines, and differing opinion influences threshold for admission[28,29], discharge[30], supplemental oxygen use[31-33], unnecessary test[34], and medication use. No study exists on the established benefit of electrocardiographic monitoring and telemetry use.…”

Section: Discussionmentioning

confidence: 99%

Utility and impact of inpatient pediatric physiologic monitoring

Gourishankar

Evangelista²,

Ellsworth³

et al. 2020

Preprint

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Objective: To study the practice and effect of monitoring pediatric patients on the hospital length of stay (LOS). Methods: We conducted a cross-sectional observational study of pediatric patients in the general ward from October to December 2016. We recorded the use of cardiac, pulse-oximeter, or both, and physician order at the time of admission. We studied the proportions of monitoring on different patient groups. The median length of stay assessed for various modes of monitoring. We did regression analysis for the effect of cardiopulmonary monitoring, orders, and medical complexity on hospital length of stay. Results: Among 398 patients, patients with cardiac monitor and pulse oximeter with orders were 68 % and 82%, respectively. The pulmonary group of patients had more monitoring than the neurology group of patients. LOS was shorter in patients without monitors; the median difference for the cardiac monitor was 1 day, and pulse oximeter was 0.5 days. Cardiac monitor order increased LOS by 22% (95% CI, 0.5% to 48%) and complex past medical history increased it by 25% (95% CI, 4% to 51%). Conclusion: Our study highlights the variable practice in using monitors, demanding a standardized approach. The judicious use of monitoring reduces prolonged hospital stay.

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Section: Discussionmentioning

confidence: 99%

Utility and impact of inpatient pediatric physiologic monitoring

Gourishankar

Evangelista²,

Ellsworth³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…De novo questions were designed to explore parental perspectives on pulse oximetry use and their experiences with the machine. Areas of focus were based on previous studies that have identified parental preference for 10 or even dependence on continuous monitoring. 21 Question creation and development were under the consultation of a local survey design expert and research psychologist (B. Halpern-Felsher, PhD; see the Acknowledgments section).…”

Section: Interview Instrument Developmentmentioning

confidence: 99%

“…9 Parental preferences for monitoring may impact the transition to intermittent pulse oximetry use because some families see frequent monitoring as a form of reassurance. 10 HVC strategies can be difficult to implement in these situations in which the recommendation for physicians is to do less than the previous standard. 11 This is particularly true when patients do not understand the potential harms of medical interventions and over rely on diagnostic tests.…”

mentioning

confidence: 99%

Parental Perspectives on Continuous Pulse Oximetry Use in Bronchiolitis Hospitalizations

et al. 2020

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BACKGROUND: Because of the impact of continuous pulse oximetry (CPOX) on the overdiagnosis of hypoxemia in bronchiolitis, the American Academy of Pediatrics and the Choosing Wisely campaign have issued recommendations for intermittent monitoring. Parental preferences for monitoring may impact adoption of these recommendations, but these perspectives are poorly understood.METHODS: Using this cross-sectional survey, we explored parental perspectives on CPOX monitoring before discharge and 1 week after bronchiolitis hospitalizations. During the 1week call, half of the participants were randomly assigned to receive a verbal statement on the potential harms of CPOX to determine if conveying the concept of overdiagnosis can change parental preferences on monitoring frequency. An aggregate variable measuring favorable perceptions of CPOX was created to determine CPOX affinity predictors. RESULTS:In-hospital interviews were completed on 357 patients, of which 306 (86%) completed the 1-week follow-up. Although 25% of parents agreed or strongly agreed that hospital monitors made them feel anxious, 98% agreed that the monitors were helpful. Compared to other vital signs, respiratory rate (87%) and oxygen saturation (84%) were commonly rated as "extremely important." Providing an educational statement on CPOX comparatively decreased parental desire for continuous monitoring (40% vs 20%; P , .001). Although there were no significant predictors of CPOX affinity, the effect size of the educational intervention was higher in college-educated parents.CONCLUSIONS: Parents find security in CPOX. A brief statement on the potential harms of CPOX use had an impact on stated monitoring preferences. Parental perspectives are important to consider because they may influence the adoption of intermittent monitoring.

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“…When McCulloh and colleagues [ 21 ] conducted a randomized controlled trial to assess outcomes associated with intermittent versus continuous pulse oximetry for nonhypoxemic infants admitted for bronchiolitis, they found that there was no difference in LOS or use of therapeutic measures between the 2 groups. Parents of children hospitalized for bronchiolitis perceive that the presence of continuous pulse oximetry monitoring is reassuring [ 22 ]. Physiological deterioration can happen to a child between routine 8-hour vital sign assessments, and further refinement on who could benefit the most from continuous cardiorespiratory monitoring for early detection of clinical deterioration is an area of much needed clarification.…”

Section: Introductionmentioning

confidence: 99%

Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis

Kowalski

Lee

Spaeder

et al. 2021

JMIR Pediatr Parent

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Background Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer. Objective The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation. Methods We conducted a retrospective cohort study of patients ≤21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer. Results During the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness. Conclusions This analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer.

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Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis

Cited by 10 publications

References 30 publications

Utility and impact of inpatient pediatric physiologic monitoring

Utility and impact of inpatient pediatric physiologic monitoring

Parental Perspectives on Continuous Pulse Oximetry Use in Bronchiolitis Hospitalizations

Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis

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