Bronchiolitis, Deception in Research, and Clinical Decision Making

Vinci, Robert J.; Bauchner, Howard

doi:10.1001/jama.2014.8638

Cited by 7 publications

(6 citation statements)

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“…Oxygen saturation measurement has become part of the vital signs in the majority of health-care centers, and it is usually adopted by health-care providers to lead their clinical evaluation of respiratory status and their decisions about safe discharge. 52 In the recent bronchiolitis guidelines, the AAP emphasized the importance of history and physical examination, and otherwise recommend little testing, treatment, or intervention including the use of continuous pulse oximetry. 1 , 53 …”

Section: Resultsmentioning

confidence: 99%

Pulse oximetry in bronchiolitis: is it needed?

Hendaus

Jomha

Alhammadi

2015

TCRM

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Infants admitted to health-care centers with acute bronchiolitis are frequently monitored with a pulse oximeter, a noninvasive method commonly used for measuring oxygen saturation. The decision to hospitalize children with bronchiolitis has been largely influenced by pulse oximetry, despite its questionable diagnostic value in delineating the severity of the illness. Many health-care providers lack the appropriate clinical fundamentals and limitations of pulse oximetry. This deficiency in knowledge might have been linked to changes in the management of bronchiolitis. The aim of this paper is to provide the current evidence on the role of pulse oximetry in bronchiolitis. We discuss the history, fundamentals of operation, and limitations of the apparatus. A search of the Google Scholar, Embase, Medline, and PubMed databases was carried out for published articles covering the use of pulse oximetry in bronchiolitis.

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Section: Resultsmentioning

confidence: 99%

Pulse oximetry in bronchiolitis: is it needed?

Hendaus

Jomha

Alhammadi

2015

TCRM

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“…[2] Although bronchiolitis is generally considered a single disease entity, the clinical course and severity are highly variable,[1,3,4] and recent studies have suggested that bronchiolitis is heterogeneous. [3,5,6] For instance, most children with bronchiolitis have a mild-to-moderate disease course, but approximately 3% require hospitalization (severe bronchiolitis). [1] Even among hospitalized children, the two most common etiologic viruses, respiratory syncytial virus (RSV) and rhinovirus, are associated with different short-term clinical outcomes (e.g., hospital length-of-stay, risk of relapse).…”

Section: Introductionmentioning

confidence: 99%

A clustering approach to identify severe bronchiolitis profiles in children

Dumas

Mansbach

Jartti

et al. 2016

Thorax

121

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Objective Although bronchiolitis is generally considered a single disease, recent studies suggest heterogeneity. We aimed to identify severe bronchiolitis profiles using a clustering approach. Methods We analyzed data from two prospective, multi-center cohorts of children younger than 2 years hospitalized with bronchiolitis, one in the U.S. (2007–2010 winter seasons, n=2,207) and one in Finland (2008–2010 winter seasons, n=408). Severe bronchiolitis profiles were determined by latent class analysis, classifying children based on clinical factors and viral etiology. Results In the U.S. study, four profiles were identified. Profile A (12%) was characterized by history of wheezing and eczema, wheezing at the ED presentation and rhinovirus infection. Profile B (36%) included children with wheezing at the ED presentation, but, in contrast to profile A, most did not have history of wheezing or eczema; this profile had the largest probability of RSV-infection. Profile C (34%) was the most severely ill group, with longer hospital stay and moderate-to-severe retractions. Profile D (17%) had the least severe illness, including non-wheezing children with shorter length-of-stay. Two of these profiles (A and D) were replicated in the Finnish cohort; a third group (“BC”) included Finnish children with characteristics of profiles B and/or C in the U.S. population. Conclusion Several distinct clinical profiles (phenotypes) were identified by a clustering approach in two multicenter studies of children hospitalized for bronchiolitis. The observed heterogeneity has important implications for future research on the etiology, management and long-term outcomes of bronchiolitis, such as future risk of childhood asthma.

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“…2,13(p 1449) Almost half of infants without hypoxia hospitalized with bronchiolitis in North American hospitals are monitored continuously. 12 This practice continues because of the weak evidence base; perceived value that nurses, physicians, and parents may place on technol-ogy when dealing with uncertainty 30,31 ; and barriers to deimplementing the established practice of continuous monitoring. 13 This trial found that clinical outcomes were similar between intermittent and continuous pulse oximetry.…”

Section: Discussionmentioning

confidence: 99%

Intermittent vs Continuous Pulse Oximetry in Hospitalized Infants With Stabilized Bronchiolitis

et al. 2021

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IMPORTANCEThere is low level of evidence and substantial practice variation regarding the use of intermittent or continuous monitoring in infants hospitalized with bronchiolitis.OBJECTIVE To compare the effect of intermittent vs continuous pulse oximetry on clinical outcomes.DESIGN, SETTING, AND PARTICIPANTS This multicenter, pragmatic randomized clinical trial included infants 4 weeks to 24 months of age who were hospitalized with bronchiolitis from November 1, 2016, to May 31, 2019, with or without supplemental oxygen after stabilization at community and children's hospitals in Ontario, Canada.INTERVENTIONS Intermittent (every 4 hours, n = 114) or continuous (n = 115) pulse oximetry, using an oxygen saturation target of 90% or higher. MAIN OUTCOMES AND MEASURESThe primary outcome was length of hospital stay from randomization to discharge. Secondary outcomes included length of stay from inpatient unit admission to discharge and outcomes measured from randomization: medical interventions, safety (intensive care unit transfer and revisits), parent anxiety and workdays missed, and nursing satisfaction. RESULTS Among 229 infants enrolled (median [IQR] age, 4.0 [2.2-8.5] months; 136 [59.4%] male; 101 [44.1%] from community hospital sites), the median length of hospital stay from randomization to discharge was 27.6 hours (interquartile range [IQR], 18.8-49.6 hours) in the intermittent group and 25.4 hours (IQR, 18.3-47.6 hours) in the continuous group (difference of medians, 2.2 hours; 95% CI, −1.9 to 6.3 hours; P = .17). No significant differences were observed between the intermittent and continuous groups in the median length of stay from inpatient unit admission to discharge: 49.1 (IQR, 37.2-87.0) hours vs 46.0 (IQR, 32.5-73.8) hours (P = .13) or in frequencies or durations of hospital interventions, such as oxygen supplementation initiation: 4 of 114 (3.5%) vs. 9 of 115 (7.8%) (P = .16) and median duration of oxygen supplementation: 20.6 (IQR, 7.6-46.1) hours vs. 21.4 (11.6-52.9) hours (P = .66). Similarly, there were no significant differences in frequencies of intensive care unit transfer: 1 of 114 (0.9%) vs 2 of 115 (2.7%) (P = .76); readmission to hospital: 3 of 114 (2.6%) in the intermittent group vs 4 of 115 (3.5%) in the continuous group (P > .99); parent anxiety: mean (SD) parent anxiety score, 2.9 (0.9) in the intermittent group vs 2.8 (0.9) in the continuous group (P = .40); or parent workdays missed: median workdays missed, 1.5 (IQR, 0.5-3.0) vs 1.5 (IQR, 0.5-2.5) (P = .36). Mean (SD) nursing satisfaction with monitoring was significantly greater in the intermittent group: 8.6 (1.7) vs 7.1 (2.8) of 10 workdays; the mean difference was 1.5 (95% CI, 0.9-2.2; P < .001). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, among infants hospitalized with stabilized bronchiolitis with and without hypoxia and managed using an oxygen saturation target of 90% or higher, clinical outcomes, including length of hospital stay and safety, were similar with intermittent vs continuous pulse oximetry. Nursing...

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Bronchiolitis, Deception in Research, and Clinical Decision Making

Cited by 7 publications

References 7 publications

Pulse oximetry in bronchiolitis: is it needed?

Pulse oximetry in bronchiolitis: is it needed?

A clustering approach to identify severe bronchiolitis profiles in children

Intermittent vs Continuous Pulse Oximetry in Hospitalized Infants With Stabilized Bronchiolitis

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