Using Pleth Variability as a Triage Tool for Children With Obstructive Airway Disease in a Pediatric Emergency Department

Brandwein, Ariel; Patel, Killol; Kline, Myriam; Silver, Peter; Gangadharan, Sandeep

doi:10.1097/pec.0000000000000887

Cited by 8 publications

(2 citation statements)

References 17 publications

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“…Brandwein et al 16 found a significant difference in the degree of PP between children discharged home versus children admitted to the hospital. They studied the Pleth Variability Index, which is a ratio of the calculated difference in maximum and minimum amplitude of the plethysmograph waveform and the maximum amplitude 16. Though our study did not evaluate the exact degree of PP, we had similar findings of a higher RR of getting admitted to HDU/ICU among those detected to have PP on the plethysmograph after initial management.…”

Section: Discussionmentioning

confidence: 98%

Oximetry-detected pulsus paradoxus predicts for severity in paediatric asthma

et al. 2020

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ObjectiveTo evaluate if qualitative visual detection of pulsus paradoxus (PP) on the pulse oximeter plethysmograph can predict outcomes for children with moderate to severe respiratory distress in a paediatric emergency department (ED).DesignProspective cohort study.SettingPaediatric ED of a tertiary paediatrics hospital in Singapore.PatientsChildren managed for moderate to severe wheezing in the resuscitation bay of the ED.InterventionsPatients were assessed for the presence of PP based on visual detection of oximeter plethysmograph before and after initial inhaled bronchodilator therapy.Main outcome measuresThese include the need for adjunct medications such as aminophylline or magnesium sulfate, the need for supplementary ventilation and the need for admission to the high dependency unit (HDU) or intensive care unit (ICU).ResultsThere were 285 patients included in the study, of whom 78 (27.4%) had PP at ED presentation. There were 40 (14.0%) who had PP after initial management. Children who had PP after initial management had significantly relative risks (RR) of requiring adjunct medications (RR 12.5, 95% CI 4.0 to 38.6), need for supplementary ventilation (RR 5.6, 95% CI 1.2 to 26.5) and admission to the HDU/ICU (RR 5.6, 95% CI 3.0 to 10.4).ConclusionQualitative detection of PP on pulse oximetry can be used as a potential point-of-care tool to help in the assessment of response to initial treatment in paediatric patients with acute moderate to severe asthma exacerbations. Future studies are needed to assess and validate its role in guiding ED management of acute paediatric asthma.

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Section: Discussionmentioning

confidence: 98%

Oximetry-detected pulsus paradoxus predicts for severity in paediatric asthma

et al. 2020

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“…Future research on these studies can enhance the understanding of these parameters, the monitoring domains, and the relations to clinical asthma outcomes. On the other hand, some hospital-based studies may provide new diagnostic opportunities such as bioimpedance [412], airway resistance during tidal breathing [413], forced oscillation technique [414], exhaled breath profiles and temperatures [415], diaphragm electromyography [416], and plethysmography variability [417][418][419]. Future research is needed to specifically review which hospital-based monitoring technologies may be beneficial for the home assessment of pediatric asthma.…”

Section: Future Perspectivesmentioning

confidence: 99%

eHealth Technologies for Monitoring Pediatric Asthma at Home: Scoping Review

Kamp¹,

Hengeveld²,

Brusse-Keizer³

et al. 2023

J Med Internet Res

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Background eHealth monitoring technologies offer opportunities to more objectively assess symptoms when they appear in daily life. Asthma is the most common chronic disease in childhood with an episodic course, requiring close follow-up of pediatric asthma control to identify disease deterioration, prevent exacerbations, and enhance quality of life. eHealth technologies in pediatric asthma care show promising results regarding feasibility, acceptability, and asthma-related health outcomes. However, broad systematic evaluations of eHealth technologies in pediatric asthma are lacking. Objective The objective of this scoping review was to identify the types and applications of eHealth technologies for monitoring and treatment in pediatric asthma and explore which monitoring domains show the most relevance or potential for future research. Methods A scoping review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic and comprehensive search was performed on English papers that investigated the development, validation, or application of eHealth technologies for home monitoring or treatment of pediatric asthma in the following databases: PubMed, Cochrane Library, IEEE, Scopus, CINAHL, PsycINFO, and ACM Digital Library. Two authors independently assessed eligibility and extracted data. Data were presented by a descriptive analysis of characteristics and a narrative report for each eHealth domain. Results The review included 370 manuscripts. The following 10 monitoring domains were identified: air quality, airway inflammation markers, lung function, physical activity, sleep, audiovisual, other physiological measurements, questionnaires, medication monitoring, and digital environment (ie, digital platforms, applications, websites, and software tools to monitor or support monitoring). Rising numbers of studies were seen, and the numbers accelerated in the last few years throughout most domains, especially medication monitoring and digital environment. Limited studies (35/370, 9.5%) of multiparameter monitoring strategies, using three or more domains, were found. The number of monitoring validation studies remained stable, while development and intervention studies increased. Intervention outcomes seemed to indicate the noninferiority and potential superiority of eHealth monitoring in pediatric asthma. Conclusions This systematic scoping review provides a unique overview of eHealth pediatric asthma monitoring studies, and it revealed that eHealth research takes place throughout different monitoring domains using different approaches. The outcomes of the review showed the potency for efficacy of most monitoring domains (especially the domains of medication monitoring, lung function, and digital environment). Future studies could focus on modifying potentially relevant hospital-based diagnostics for the home setting to investigate potential beneficial effects and focus on combining home-monitoring domains to facilitate multiparameter decision-making and personalized clinical decision support.

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