Prevalence of Continuous Pulse Oximetry Monitoring in Hospitalized Children With Bronchiolitis Not Requiring Supplemental Oxygen

To measure continuous pulse oximetry use in children with bronchiolitis.

A multicenter cross-sectional study was performed in pediatric wards in 56 US and Canadian hospitals in the Pediatric Research in Inpatient Settings Network from December 1, 2018, through March 31, 2019.

Participants included a convenience sample of patients aged 8 weeks through 23 months with bronchiolitis who were not receiving active supplemental oxygen administration. Patients with extreme prematurity, cyanotic congenital heart disease, pulmonary hypertension, home respiratory support, neuromuscular disease, immunodeficiency, or cancer were excluded.

The sample included 3612 patient observations in 33 freestanding children’s hospitals, 14 children’s hospitals within hospitals, and 9 community hospitals. In the sample, 59% were male, 56% were white, and 15% were Black; 48% were aged 8 weeks through 5 months, 28% were aged 6 through 11 months, 16% were aged 12 through 17 months, and 9% were aged 18 through 23 months. The overall continuous pulse oximetry monitoring use percentage in these patients, none of whom were receiving any supplemental oxygen or nasal cannula flow, was 46% (95% CI, 40%–53%). Hospital-level unadjusted continuous pulse oximetry use ranged from 2% to 92%. After risk standardization, use ranged from 6% to 82%. Intraclass correlation coefficient suggested that 27% (95% CI, 19%–36%) of observed variation was attributable to unmeasured hospital-level factors.

In a convenience sample of children hospitalized with bronchiolitis who were not receiving active supplemental oxygen administration, monitoring with continuous pulse oximetry was frequent and varied widely among hospitals. Because of the apparent absence of a guideline or evidence-based indication for continuous monitoring in this population, this practice may represent overuse.

For many clinicians, the treatment of bronchiolitis revolves specifically around supportive care, previous attempts of inhaled steroids, short-acting β-agonists, or oral steroids have been found to be ineffective in shortening hospital stays or clinical outcomes. Even with inpatient observation, it is clear that use of continuous pulse oximetry in children not receiving continuous supplemental oxygen is likely unnecessary, and alternative measures of clinical status should be considered. For clinicians struggling to support families at home, this also may indicate the use of home pulse oximetry measurements by caregivers does not assist in identifying children in true respiratory distress and is likely overused with little benefit.