Prolonged, documented home-monitoring of oxygenation in infants and children
Jean-François Gélinas1, G Michael Davis, Cheryl Arlegui
1Respiratory Medicine Division, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Canada.
Insights
Home pulse oximetry with adjusted alarm settings effectively alerted parents to significant cardiorespiratory events in children. This approach balanced early detection with a reduced rate of non-significant alarms, improving home monitoring safety.
Area of Science:
- Pediatric Pulmonology
- Medical Device Technology
- Clinical Monitoring
Background:
- Home cardiorespiratory monitors lack oxygenation data.
- Pulse oximeters offer improved oxygenation monitoring but lack standardized alarm settings.
- Establishing appropriate alarm thresholds is crucial for effective home monitoring.
Purpose of the Study:
- To evaluate the efficacy of home pulse oximeter alarm levels in identifying significant events in children.
- To assess the ability of adjusted alarm settings to minimize false alarms for non-significant events.
- To determine safe and effective alarm parameters for pediatric home pulse oximetry.
Main Methods:
- Retrospective cohort study of 37 children using home pulse oximeters (2002-2007).
- Analysis of 24,127 hours of recorded hemoglobin oxygen saturation (SpO2) data.
- Audible alarms were set at SpO2 levels of 85% with 0, 5, or 10-second delays.
Main Results:
- An alarm delay of 5 or 10 seconds significantly reduced alarm frequency (0.9 and 0.2 alarms/night, respectively) compared to no delay (3.6 alarms/night).
- Thirteen patients required intervention following alarms.
- Ten patients were readmitted due to frequent alarms, confirmed as true events on recordings, despite no clinical deterioration.
Conclusions:
- Home pulse oximetry with optimized alarm settings can effectively alert caregivers to potentially dangerous events.
- Adjusting alarm parameters is key to limiting non-significant alarms, enhancing the utility of home monitoring.
- This study supports the use of tailored pulse oximeter alarms for safe and efficient pediatric home monitoring.
Rationale:
Although home cardiorespiratory monitors have been used for a few decades, they do not give information on oxygenation status during events. Pulse oximeters with low false-alarm rates are now available but with no standards for alarm adjustment.
Objective:
To determine, in a population of children monitored at home with a pulse oximeter, whether the chosen alarm levels could safely identify potentially significant events early on but also limit the number of alarms for non-significant events.
Methods:
Retrospective cohort study of all children monitored at home with a pulse oximeter (n = 37) between 2002 and 2007. Clinical information and Hb-O(2) saturation (SpO(2)) recordings were reviewed. Audible alarm was set-up when SpO(2) reached 85% with a delay of 5 or 10 sec.
Results:
A total of 24,127 hr of valid data were available for analysis. There were 13,228 events >4 sec of which 9177 (69%) were events lasting <10 sec. We determine that, with an audible alarm being triggered when SpO(2) reached 85% with no delay or a delay of 5 or 10 sec, audible alarms would have occurred at a rate of 3.6, 0.9, and 0.2 alarm/night (median), respectively. Thirteen patients needed intervention following alarms. Ten patients were readmitted to the hospital on the basis of increased frequency of alarms confirmed as true events on the recordings, but in the absence of clinical deterioration.
Conclusion:
The monitor was able to alert parents as to potentially dangerous events while the alarm adjustment limited the number of alarms for non-significant events.
Related Concept Videos
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:30Administering Oxygen by Mask
Administering oxygen by mask is a common nursing intervention that provides supplemental oxygen to patients with respiratory distress or chronic lung conditions. This procedure involves delivering oxygen at a specified rate through a face mask connected to an oxygen source.
Equipment
The equipment necessary for this procedure includes:
01:19Special considerations while measuring oxygen saturation
Ensuring accuracy in vital sign recordings while prioritizing patient comfort and minimizing anxiety is important.
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:16Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue, improving...