Investigators from multiple institutions conducted a multicenter, cross-sectional study to assess the use of continuous pulse oximetry (cSpO2) in children hospitalized for bronchiolitis but not needing supplemental oxygen. Patients were eligible if they were (a) 8 weeks through 23 months old, (b) admitted with bronchiolitis from December 2018 to March 2019 to an acute (nonintensive) care ward at a hospital that belongs to the Pediatric Research in Inpatient Settings (PRIS) network, and (c) not receiving any supplemental oxygen at the time of data collection. Patients were excluded if they were born at <28 weeks’ gestation or had cyanotic congenital heart disease, pulmonary hypertension, a home oxygen requirement, or tracheostomy. Demographics and clinical characteristics of participants were obtained from the medical record, including age (categorized as 8 weeks-5 months, 6–11 months, 12–17 months, and 18–23 months), race, gestational age, time since weaning supplemental oxygen (categorized as never received oxygen and <1, 1–<2, 2–<4, 4–<6, 6–<12, 12–<24, and ≥24 hours), history of apnea or cyanosis during present illness, hospital type (categorized as freestanding children’s hospital, children’s hospital within hospital, and community hospital), and comorbid conditions associated with neurologic impairment.
The primary outcome was use of cSpO2, determined via visual confirmation by study staff. Staff conducted observations during daytime hours as well as at night. Investigators calculated the cSpO2 use percentage by dividing the number of observations in which use of cSpO2 was confirmed by the total number of observations. Investigators used multivariable logistic regression to identify factors that were independently associated with cSpO2 use after adjusting for potential confounders.
There were 3,525 patient observations at 49 PRIS hospitals included in analysis. The overall percentage of cSpO2 use was 46% (95% CI, 40%–53%). In multivariable analyses, several variables were associated with cSpO2 use, including age (8-week to 5-month-olds had a 1.51 [95% CI, 1.12–2.03] increased odds of cSpO2 use compared to 18- to 23-month-olds), time since weaning supplemental oxygen (those weaned within 2–<4 hours had the highest odds of cSpO2 use compared to those who never had received oxygen [adjusted odds ratio, aOR, 5.55; 95% CI, 3.91–7.89]), history of apnea or cyanosis during present illness (aOR, 1.40; 95% CI, 1.01–1.93), and nighttime observation (aOR, 2.07; 95% CI, 1.76–2.43).
The investigators conclude that cSpO2 use in children admitted for bronchiolitis who do not need supplemental oxygen is frequent.
Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
The current provocative study addresses a vexing issue in the management of bronchiolitis among patients on room air. Why do we persist with cSpO2 when several...