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Original Investigation | Journal Club

Use of Intermittent vs Continuous Pulse Oximetry for Nonhypoxemic Infants and Young Children Hospitalized for Bronchiolitis A Randomized Clinical Trial

Russell McCulloh, MD1; Michael Koster, MD2; Shawn Ralston, MD3; Matthew Johnson, MD1; Vanessa Hill, MD4; Kristin Koehn, MD5; Gina Weddle, DNP1; Brian Alverson, MD2
[+] Author Affiliations
1Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
2Department of Pediatrics, Hasbro Children’s Hospital, Providence, Rhode Island
3Department of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock, Hanover, New Hampshire
4Department of Pediatrics, Children’s Hospital of San Antonio, San Antonio, Texas
5Department of Child Health, University of Missouri Women and Children’s Hospital, Columbia
JAMA Pediatr. 2015;169(10):898-904. doi:10.1001/jamapediatrics.2015.1746.
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Importance  Clinical practice guidelines for managing infants and children hospitalized for bronchiolitis recommend only obtaining intermittent or “spot check” pulse oximetry readings for those who show clinical improvement. The effect of such monitoring is currently unknown.

Objective  To determine the effect of intermittent vs continuous pulse oximetry monitoring on hospital length of stay among nonhypoxemic infants and young children hospitalized for bronchiolitis.

Design, Setting, and Participants  Randomized, parallel-group, superiority clinical trial of otherwise healthy infants and children 2 years of age or younger hospitalized for bronchiolitis during the period from 2009 to 2014 at 1 of 4 children’s hospitals in the United States. Parents or guardians were blinded to allocation assignment until informed consent was obtained; study personnel and outcome assessors were not.

Interventions  Patients were randomly assigned to undergo continuous or intermittent pulse oximetry monitoring (ie, pulse oximetry measurements were obtained along with a scheduled check of vital signs or for clinical suspicion of deterioration) during hospitalization when oxygen saturation levels were 90% or higher.

Main Outcomes and Measures  Length of hospital stay was the primary outcome. Secondary outcome measures included duration of supplemental oxygen use and rate of escalation of care (defined as transfer to an intensive care unit).

Results  A total of 449 infants and young children were screened for inclusion; 288 infants and young children were excluded, resulting in 161 patients who were enrolled in the study (80 patients underwent continuous monitoring, and 81 patients intermittent). The mean length of stay did not differ based on pulse oximetry monitoring strategy (48.9 hours [95% CI, 41.3-56.5 hours] for continuous monitoring vs 46.2 hours [95% CI, 39.1-53.3 hours] for intermittent monitoring; P = .77). The rates of escalation of care and duration of supplemental oxygen use did not differ between groups.

Conclusions and Relevance  Intermittent pulse oximetry monitoring of nonhypoxemic patients with bronchiolitis did not shorten hospital length of stay and was not associated with any difference in rate of escalation of care or use of diagnostic or therapeutic measures. Our results suggest that intermittent pulse oximetry monitoring can be routinely considered in the management of infants and children hospitalized for bronchiolitis who show clinical improvement.

Trial Registration  clinicaltrials.gov Identifier:NCT01014910

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Figure 2.
Kaplan-Meier Curve of Time to Hospital Discharge Based on Oximetry Monitoring Strategy
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Figure 1.
CONSORT Diagram of Screening and Enrollment

CONSORT indicates Consolidated Standards of Reporting Trials; and PICU, pediatric intensive care unit.

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