Kula o ka ʻepekema Ola a me ka Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland, Sunderland, UK
Nicholas Harland, Kula o ka Ola Ola a me ka Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
Kula o ka ʻepekema Ola a me ka Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland, Sunderland, UK
Nicholas Harland, Kula o ka Ola Ola a me ka Welfare, Helen McArdle Institute of Nursing and Nursing, University of Sunderland City Campus, Chester Road, Sunderland SR1 3SD, UK.
E hoʻohana i ka loulou ma lalo nei e kaʻana like i ka mana kikokikona piha o kēia ʻatikala me kāu mau hoaaloha a me nā hoa hana.Aʻo hou mai.
Ua hoʻoikaika ʻia ka lawelawe COVID-19 Oximetry@Home ma ka ʻāina holoʻokoʻa.ʻAe kēia i nā poʻe maʻi koʻikoʻi me nā hōʻailona COVID-19 haʻahaʻa e noho ma ka home a loaʻa ka pulse oximeter e ana i ko lākou oxygen saturation (SpO2) 2 a 3 mau manawa i ka lā no ʻelua pule.Hoʻopaʻa ka poʻe maʻi i kā lākou heluhelu ʻana me ka lima a i ʻole ka uila a nānā ʻia e ka hui lapaʻau.Hoʻoholo ʻia ka hoʻoholo lapaʻau no ka hoʻohana ʻana i ka algorithm ma nā heluhelu SpO2 i loko o kahi ākea liʻiliʻi, kahi e hoʻololi ai nā helu 1-2 i ka mālama.Ma kēia ʻatikala, ua kūkākūkā mākou i nā mea he nui e pili ana i ka heluhelu SpO2, a e loaʻa i kekahi poʻe "maʻamau" ka helu "haʻahaʻa maʻamau" ma ka paepae hoʻokele lapaʻau me ka ʻole o nā pilikia hanu i ʻike ʻia.Ua kūkākūkā mākou i ke koʻikoʻi o kēia pilikia e pili ana i nā palapala pili, a noʻonoʻo i ka hopena o kēia i ka hoʻohana ʻana i ka lawelawe ʻo Oximetry@home, kahi e huikau ai i kāna kumu;e hoemi i ka lapaau maka-a-maka.
Nui nā pōmaikaʻi i ka hoʻokele ʻana i nā hihia COVID-19 liʻiliʻi i ke kaiāulu, ʻoiai ke kaupalena nei kēia i ka hoʻohana ʻana i nā mea lapaʻau e like me nā thermometers, stethoscopes, a me nā pulse oximeters i ka wā o ka loiloi.Eia nō naʻe, no ka mea he mea pono ke ana ʻana o ka pulse oximetry ma ka home i ka pale ʻana i nā kipa ʻoihana pilikia ʻole (Torjesen, 2020) a me ka ʻike mua ʻana o ka asymptomatic hypoxia, akā naʻe, ʻōlelo ʻo NHS ʻEnelani i ka ʻāina holoʻokoʻa E hilinaʻi i ka lawelawe "Spo2 Measurement@Home" (NHSE). , 2020a)) No nā poʻe maʻi me nā hōʻailona COVID-19 maʻalahi akā ʻoi aku ka nui o ka maʻi o ka maʻi, hiki ke hoʻohana ʻia kahi pulse oximeter no 14 mau lā o ka mālama ʻana, no laila ʻo 2-3 mau manawa i ka lā Ka nānā ʻana iā ia iho i kona saturation oxygen (SpO2) .
ʻO ka poʻe maʻi i kuhikuhi ʻia i ka lawelawe Oximetry@Home e kuhikuhi pinepine ʻia e hoʻohana i kahi app a i ʻole diary pepa e hoʻopaʻa i kā lākou ʻike.Hāʻawi ka app i nā pane / ʻōlelo paipai, a i ʻole ke kauka ke nānā i ka ʻikepili.Inā pono, hiki i ke kauka ke hoʻopili i ka mea maʻi, akā maʻamau wale nō i nā hola hana maʻamau.Hōʻike ʻia nā maʻi pehea e wehewehe ai i kā lākou hopena i hiki iā lākou ke hana kūʻokoʻa inā pono, e like me ka ʻimi ʻana i ka mālama pilikia.Ma muli o ke kiʻekiʻe o ka piʻi ʻana o ka maʻi, ʻo ka poʻe ma mua o 65 mau makahiki a me / a i ʻole me nā comorbidities he nui i wehewehe ʻia he palupalu loa ke lilo i kumu o kēia ala (NHSE, 2020a).
ʻO ka loiloi o nā maʻi ma ka lawelawe Oximetry@Home e ana mua i ko lākou oxygen saturation ma o ka pulse oximeter SpO2, a laila e noʻonoʻo i nā hōʻailona a me nā hōʻailona ʻē aʻe.Ke hoʻohana nei i ka ʻulaʻula, amber, a me ka ʻōmaʻomaʻo (RAG) nā helu, inā he 92% a haʻahaʻa paha ka SpO2 o ka mea maʻi, ua helu ʻia ka mea maʻi e like me ka ʻulaʻula, a inā kā lākou SpO2 he 93% a i ʻole 94%, ua helu ʻia lākou e like me ka amber, inā inā kā lākou SpO2 ʻo 95% a ʻoi aku paha, ua helu ʻia lākou he ʻōmaʻomaʻo.ʻO ka maʻamau, ʻo nā mea maʻi ʻōmaʻomaʻo wale nō ke kūpono e hoʻohana iā Oximetry@Home (NHSE, 2020b).Eia nō naʻe, hiki i nā ʻano mea like ʻole pili i ka maʻi ke hoʻopili i ka helu SpO2, a ʻaʻole hiki ke noʻonoʻo ʻia kēia mau mea ma ke ala.Ma kēia ʻatikala, ua kūkākūkā mākou i nā mea like ʻole e pili ana iā SpO2 e pili ana i ke komo ʻana o ka poʻe maʻi i nā lawelawe Oximetry@Home.Hiki paha i kēia mau mea ke huikau i kāna kumu o ka hoʻemi ʻana i ke kaomi o nā lawelawe lapaʻau maka-a-maka.
ʻO ka laulā o ka "maʻamau" koko oxygen saturation i ana ʻia e ka pulse oximeter (SpO2) ʻo 95% -99%.ʻOiai ka loaʻa ʻana o nā palapala e like me ka World Health Organization Pulse Oximetry Training Manual (WHO, 2011), ʻo ia ka ʻōlelo ma nā wahi a pau a ʻaʻole hiki ke haʻi ʻia nā ʻatikala olakino.I ka ʻimi ʻana i ka ʻikepili hoʻoponopono ma SpO2 i nā heluna kanaka ʻole, ʻike liʻiliʻi ka ʻike.Ma kahi noiʻi o 791 poʻe 65 makahiki a ʻoi aku (Rodríguez-Molinero et al., 2013), ma hope o ka noʻonoʻo ʻana i nā ʻano like me COPD, ʻo ka awelika 5% SpO2 helu he 92%, e hōʻike ana i kahi ana 5% ʻO ke koko oxygen saturation o ka heluna kanaka. ʻoi aku ka haʻahaʻa ma mua o kēlā me ka ʻole o ka wehewehe ʻana i ka lāʻau lapaʻau.Ma kahi noiʻi ʻē aʻe o 458 mau kānaka makahiki 40-79 (Enright & Sherrill, 1998), ʻo ka nui o ka oxygen saturation ma mua o ka hoʻāʻo ʻana he 6 mau minuke he 92% -98% i ka 5th percentile, a ma ka 95th percentile.ʻO ka pākēneka mua he 93% -99% pākēneka.ʻAʻole i kākau nā haʻawina ʻelua i nā kaʻina hana i hoʻohana ʻia no ke ana ʻana iā SpO2 i nā kikoʻī.
Ua ʻike ʻia kahi noiʻi heluna kanaka o 5,152 poʻe ma Norewai (Vold et al., 2015) he 11.5% o ka poʻe i loaʻa iā SpO2 ma lalo a i ʻole like me ka 95% haʻahaʻa a haʻahaʻa paha o ka palena maʻamau.I loko o kēia haʻawina, he kakaikahi wale nō ka poʻe me ka SpO2 haʻahaʻa i hōʻike ʻia i loaʻa i ka hānō (18%) a i ʻole COPD (13%), aʻo ka hapa nui o nā poʻe me ka BMI koʻikoʻi ma mua o 25 (77%) a ua nui ʻO kekahi he 70 mau makahiki a i ʻole. kahiko (46%).Ma United Kingdom, 24.4% o nā hihia i hoʻāʻo ʻia no COVID-19 ma waena o Mei a me ʻAukake 2020 he 60 mau makahiki a ʻoi paha, a ʻo 15% he 70 mau makahiki a ʻoi paha [8] (Ministry of Health and Social Care, 2020).ʻOiai ʻo ka noiʻi Norwegian e hōʻike ana he 11.5% o kekahi heluna kanaka he SpO2 haʻahaʻa, a ʻo ka hapa nui o kēia mau hihia ʻaʻole i ʻike ʻia ka maʻi hanu hanu, ua hōʻike ka palapala i hiki ke loaʻa nā "miliona" o ka COPD i ʻike ʻole ʻia (Bakerly & Cardwell, 2016) A hiki paha. kiʻekiʻe o ka undiagnosed obesity hypoventilation syndromes (Masa et al., 2019).Hiki i ka helu helu helu o nā helu SpO2 "haʻahaʻa maʻamau" ʻike ʻole ʻia i loaʻa i nā noiʻi heluna kanaka i loaʻa i nā maʻi hanu undiagnosed.
Ma waho aʻe o ka ʻokoʻa holoʻokoʻa, hiki i nā mea kikoʻī o ka protocol i hoʻohana ʻia no ke ana ʻana iā SpO2 hiki ke hoʻopili i nā hopena.Aia kekahi ʻokoʻa koʻikoʻi ma waena o ke ana ʻana i ka wā hoʻomaha a me ke ana ʻana i ka wā e noho ana (Ceylan et al., 2015).Eia kekahi, e like me nā makahiki a me nā mea momona, hiki ke emi ʻo SpO2 i loko o 5-15 mau minuke o ka hoʻomaha (Mehta a me Parmar, 2017), ʻoi aku ka nui o ka noʻonoʻo ʻana (Bernardi et al., 2017).Hiki ke loaʻa ka hopena koʻikoʻi (Khan et al., 2015), e like me ka hopohopo, a ʻo ka hele ʻana o ka hopohopo e hōʻemi i nā helu ma kahi kiko piha (Ardaa et al., 2020).ʻO ka mea hope loa, ua ʻike ʻia ʻo ka hewa maʻamau o ke ana ʻana o ka pulse oximeter he ± 2% ke hoʻohālikelike ʻia me ke ana ʻana o ke kinoea koko arterial synchronized SaO2 (American Thoracic Society, 2018), akā mai kahi ʻano lapaʻau, mai kahi ʻike kūpono. no ka mea, ʻaʻohe ala e noʻonoʻo ai i kēia ʻokoʻa, pono e ana ʻia a hana ʻia ma ke kumu waiwai.
ʻO ka hoʻololi ʻana i ka SpO2 i ka manawa a me nā ana hou ʻana he pilikia ʻē aʻe, a he liʻiliʻi loa ka ʻike e pili ana i kēia ma ka heluna kanaka ʻole.Ua nānā ʻia kahi haʻawina liʻiliʻi liʻiliʻi (n = 36) i nā loli SpO2 i loko o hoʻokahi hola [16] (Bhogal & Mani, 2017), akā ʻaʻole i hōʻike i ke ʻano like ʻole i ka wā e ana mau ana i kekahi mau pule, e like me ka Oximetry@ During Home.
I loko o ka 14-lā Oximetry@Home kiaʻi manawa, SpO2 ua ana 3 manawa i ka lā, a hiki ke oi pinepine no na maʻi hopohopo, a 42 ana hiki ke lawe.ʻOiai ke manaʻo nei ua hoʻohana ʻia ka protocol ana like i kēlā me kēia hihia a paʻa ke kūlana olakino, aia ke kumu e manaʻoʻiʻo ai aia kekahi ʻokoʻa i kēia mau ana.Hōʻike nā haʻawina heluna kanaka me ka hoʻohana ʻana i hoʻokahi ana i ka 11.5% o nā kānaka i loaʻa iā SpO2 o 95% a i ʻole.I ka hala ʻana o ka manawa, ʻoi aku ka lōʻihi o ka loaʻa ʻana o kahi heluhelu haʻahaʻa i ka wā e ana pinepine ʻia i ka manawa COVID -19 ʻoi aku ka kiʻekiʻe ma mua o 11.5%.
Hōʻike ka algorithm ma hope o ka lawelawe Oximetry@Home e pili ana nā hopena maikaʻi ʻole me nā helu SpO2 haʻahaʻa [17] (Shah et al., 2020);ʻO ka poʻe me SpO2 e hāʻule ana i ka 93% a hiki i ka 94% pono e loaʻa i ka loiloi olakino maka-a-maka a noʻonoʻo ʻia no ke komo ʻana, 92 % A ma lalo e loaʻa ka mālama olakino lua.Me ka hoʻokō ʻana i ka lawelawe ʻo Oximetry@Home ma ka ʻāina holoʻokoʻa, ʻo nā ana SpO2 hou i lawe ʻia e nā mea maʻi ma ka home e lilo i mea nui i ka wehewehe ʻana i ko lākou kūlana lapaʻau.
Hoʻohana pinepine ʻia ke ana SpO2 i loko o kahi manawa pōkole ke kau ʻia ka oximeter.Noho ka mea maʻi me ka hoʻomaha ʻole no kekahi manawa.ʻO ka hele wāwae ʻana mai kahi e kali ai a hiki i ka wahi lapaʻau e hoʻopilikia kino i ke koena.Me ka hana ʻana o ka lawelawe Oximetry@Home, ua hoʻokuʻu ʻia ka wikiō NHS YouTube (2020).Manaʻo ka wikiō i nā poʻe maʻi e lawe ana i nā ana ma ka home e moe i lalo no 5 mau minuke, e kau i ka oximeter, a laila e loaʻa ka heluhelu paʻa loa 1 mau minuke ma hope o ke kau ʻana.Ua hoʻolaha ʻia kēia loulou wikiō ma o ka ʻaoʻao o ka NHS collaboration platform e hiki mai ana e pili ana i ka mea e hoʻonohonoho ana i ka lawelawe Oximetry@Home, akā ʻaʻole ia e hōʻike i ka hāʻawi ʻana i nā heluhelu haʻahaʻa i hoʻohālikelike ʻia i nā heluhelu i lawe ʻia i ka wā e noho ana.He mea pono e hoʻomaopopo i kekahi wikiō hoʻonaʻauao olakino NHS ma ʻEnelani ma ka nūpepa Daily Mail e hōʻike i kahi protocol ʻokoʻa loa, ʻo ia ka heluhelu ʻana i ka wā e noho ana (Daily Mail, 2020).
Ma kahi kanaka i ʻike ʻole ʻia, he helu haʻahaʻa o 95%, ʻo kahi hāʻule o ka helu 1 ma muli o ka maʻi COVID-19 hiki ke hopena i kahi helu Amber, e alakaʻi ana i ka mālama lapaʻau pololei.ʻO ka mea maopopo ʻole inā e hoʻohana ʻia ka mālama lapaʻau pololei i nā kumuwaiwai ma waena o nā poʻe me nā helu pre-morbid haʻahaʻa.
ʻOiai ua ʻōlelo pū ka algorithm ʻāina i ka hāʻule ʻana o SpO2, no ka mea ʻaʻole i hoʻopaʻa ka hapa nui o nā hihia i ka helu SpO2 ma mua o ka maʻi, ʻaʻole hiki ke loiloi ʻia kēia helu ma mua o ka hāʻule mua ʻana e ka maʻi i kumu i ka loiloi SpO2.Mai ka manaʻo hoʻoholo, ʻaʻole maopopo i ke kino inā pono ke hoʻohana ʻia ka saturation/perfusion kiʻekiʻe o ke kanaka i ka wā e noho ana ma ke ʻano he kumu no ka mālama ʻana i ka ʻiʻo, a i ʻole e hoʻohana ʻia ke kiʻekiʻe saturation/perfusion i hoʻemi ʻia i ka wā e moe ana ma hope o ka hoʻomaha. laina kumu.Me he mea lā ʻaʻole he kulekele i ʻae ʻia e ka ʻāina no kēia.
ʻO SpO2% kahi ʻāpana i loaʻa i ka lehulehu no ka loiloi COVID-19.Ua kūʻai aku ʻo NHS ʻEnelani i 370,000 oximeters no ka hoʻohana ʻana e nā maʻi he nui no ka hāʻawi ʻana i nā lawelawe.
Hiki i nā mea i wehewehe ʻia ke hoʻololi i ke ana ʻana o ka SpO2 hoʻokahi kikoʻī, e hoʻoulu ai i nā loiloi maʻi maka-a-maka ma ka mālama mua a i ʻole ke keʻena pilikia.I ka wā lōʻihi, hiki ke nānā ʻia nā kaukani o nā maʻi ma ke kaiāulu no SpO2, hiki ke alakaʻi i ka nui o nā loiloi maka-a-maka pono ʻole.Ke nānā ʻia ka hopena o nā mea e pili ana i ka heluhelu SpO2 i nā hihia COVID-19 a hoʻokomo ʻia i loko o ka pōʻaiapili o ka heluna kanaka a me nā ana hale, ʻoi aku ka nui o ka hopena i ka helu helu, ʻoi aku hoʻi no kēlā mau "miliona nalo" ʻoi aku ka nui o ka SpO2 koʻikoʻi.Eia kekahi, ʻoi aku ka maikaʻi o ka lawelawe ʻo Oximetry@Home e koho i nā poʻe me ka helu ʻoki ʻia e ka huli ʻana i nā poʻe ma luna o 65 a me ka poʻe i loaʻa ka BMI kiʻekiʻe e pili ana i nā comorbidities.Ua hōʻike nā haʻawina e helu ana ka heluna kanaka "haʻahaʻa maʻamau" ma kahi o 11.5% o nā kānaka a pau, akā ma muli o nā koho koho o ka lawelawe Oximetry@Home, ʻoi aku ka nui o kēia pākēneka.
No ka mea, aia nā mea i kākau ʻia e hoʻoikaika i nā helu SpO2, hiki i nā poʻe maʻi me nā helu haʻahaʻa maʻamau, ʻoi aku ka nui o nā helu he 95%, hiki ke neʻe ma waena o nā helu ʻōmaʻomaʻo a me ka amber i nā manawa he nui.Hiki paha kēia hana ma waena o ke ana hoʻomaʻamaʻa maʻamau i ka wā i kuhikuhi ʻia ai iā Oximetry@Home a me ke ana mua i ka wā e hoʻohana ai ka mea maʻi i ka protocol moe 6 mau minuke ma ka home.Inā maikaʻi ʻole ka mea maʻi, hiki i ka hopohopo i ka wā o ke ana ke hōʻemi i ka poʻe me ka helu ʻoki ʻia ma lalo o 95% a ʻimi i ka mālama.Hiki i kēia ke hopena i ka mālama maka-a-maka pono ʻole, e hoʻokau hou i nā lawelawe i hiki a ʻoi aku paha i ka hiki.
ʻOiai ma waho o ke ala Oximetry@Home i kauoha ʻia a me nā lako lapaʻau e hāʻawi ana i nā mea maʻi me nā oximeters, ua pālahalaha ʻia nā nūhou e pili ana i ka pono o nā pulse oximeters, a ʻaʻole ʻike ʻia ka nui o ka poʻe i loaʻa nā oximeters pulse i ka pane ʻana i ka maʻi maʻi COVID -19, ʻoiai. nui nā mea kūʻai like ʻole e hāʻawi ana i nā mea hana maʻalahi a me nā hōʻike o nā lako i kūʻai ʻia (CNN, 2020), aia paha kēia helu ma kahi o nā haneli haneli.Hiki i nā mea i wehewehe ʻia ma kēia ʻatikala ke hoʻopili i kēia poʻe a hoʻokau hou aku i ke koʻikoʻi i ka lawelawe.
Ke haʻi aku nei mākou ua hāʻawi nui nā mea kākau i helu ʻia i ka hana ʻana i kēia ʻatikala, a ua hāʻawi i nā manaʻo a me nā mea i kākau ʻia.
Ma muli o ka ʻae ʻia ʻana o ke kōmike loiloi palapala a me ke kōmike koʻikoʻi noiʻi, ʻaʻole pili ia i ka waiho ʻana o kēia ʻatikala.
ʻAʻole pili ka kaʻana like ʻikepili i kēia ʻatikala no ka mea ʻaʻohe pūʻulu ʻikepili i hana ʻia a i kālailai ʻia i ka wā noiʻi o kēia manawa.
E ʻoluʻolu e nānā i kāu leka uila no nā ʻōlelo aʻoaʻo no ka hoʻihoʻi ʻana i kāu ʻōlelo huna.Inā ʻaʻole i loaʻa iā ʻoe kahi leka uila i loko o 10 mau minuke, ʻaʻole i hoʻopaʻa inoa ʻia kāu leka uila a pono ʻoe e hana i kahi moʻokāki Wiley Online Library hou.
Inā pili ka helu wahi i kahi moʻokāki i loaʻa iā ʻoe, e loaʻa iā ʻoe kahi leka uila me nā kuhikuhi no ka hoʻihoʻi ʻana i ka inoa inoa
Ka manawa hoʻouna: Iulai-15-2021