Outpatient Course and Complications Associated With Home Oxygen Therapy for Mild Bronchiolitis

Abstract

BACKGROUND: Home oxygen has been incorporated into the emergency department management of bronchiolitis in high-altitude settings. However, the outpatient course on oxygen therapy and factors associated with subsequent admission have not been fully defined. METHODS: We conducted a retrospective cohort study in consecutive patients discharged on home oxygen from the pediatric emergency department at Denver Health Medical Center from 2003 to 2009. The integration of inpatient and outpatient care at our study institution allowed comprehensive assessment of follow-up rates, outpatient visits, time on oxygen, and subsequent admission. Admitted and nonadmitted patients were compared by using a χ2 test and multivariable logistic regression. RESULTS: We identified 234 unique visits with adequate follow-up for inclusion. The median age was 10 months (interquartile range [IQR]: 7–14 months). Eighty-three percent of patients were followed up within 24 hours and 94% within 48 hours. The median length of oxygen use was 6 days (IQR: 4–9 days), and the median number of associated encounters was 3 (range: 0–9; IQR: 2–3). Ninety-three percent of patients were on room air at 14 days. Twenty-two patients (9.4%) required subsequent admission. Fever at the initial visit (>38.0°C) was associated with admission (P < .02) but had a positive predictive value of 15.4%. Age, prematurity, respiratory rate, oxygen saturation, and history of previous bronchiolitis or wheeze were not associated with admission. CONCLUSIONS: There is a significant outpatient burden associated with home oxygen use. Although fever was associated with admission, we were unable to identify predictors that could modify current protocols.

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

“…118,119 Most of the studies have been performed in areas of higher altitude, where prolonged hypoxemia is a prime determinant of LOS in the hospital. 120,121 Readmission rates may be moderately higher in patients discharged with home oxygen; however, overall hospital use may be reduced, 122 although not in all settings. 123 Concerns have been raised that home pulse oximetry may complicate care or confuse families.…”

Oxygen saturations targets in infants with bronchiolitis: Is 90% as effective as 94%?

“…We question the use of cough as an outcome. Cough has not been shown to contribute to readmission rates in children with acute bronchiolitis discharged on home oxygen and has not been identified as a barrier to discharge in patients with bronchiolitis including those with an oxygen requirement . The secondary outcomes in this study (time to normal feeding and time to fit for discharge) are more clinically relevant.…”

Neonatal resuscitation with no detectable heartbeat

“…We question the use of cough as an outcome. Cough has not been shown to contribute to readmission rates in children with acute bronchiolitis discharged on home oxygen 2 and has not been identified as a barrier to discharge in patients with bronchiolitis including those with an oxygen requirement. 3 The secondary outcomes in this study (time to normal feeding and time to fit for discharge) are more clinically relevant.…”

“…Shah et al 1 recently published a study on the long term outcomes for infants with Apgar scores of 0 at 10 minutes and concluded that longterm outcomes for survivors may not be universally poor as suggested by previous studies. 2 The decision to stop resuscitation can be very challenging even for experienced paediatricians. The major clinical question is what proportion of these infants survive without major neurological sequelae if resuscitation proceeds beyond the 10 minutes advised by the Australian Resuscitation Council.…”