Oxygen saturation thresholds in bronchiolitis: examining admissions

Abstract

ObjectiveExamine admissions for bronchiolitis, comparing centres with oxygen saturation thresholds for admission of 90% versus 92%.DesignProspective multi-centre service evaluation, all admissions for bronchiolitis during 4-week period, November 2018.SettingPaediatric departments across 12 hospitals in the West Midlands, UK.Patients320 patients aged 6 weeks–1 year, diagnosis of bronchiolitis, exclusions: chronic illness or high dependency/intensive care admission.Main outcome measuresReason for admission, admission saturations and length of stay.ResultsInadequate feeding was the the most common reason for admission (80%). Only 20 patients were admitted solely because of low saturations. Median peripheral oxygen saturation in this group was 88%. Median length of stay in 90% centres was 41 hours, against 59 hours for 92% centres (p=0.0074).ConclusionsFew patients were admitted solely due to low oxygen saturations, only one had a potentially avoidable admission if thresholds were 90%. Length of stay was significantly reduced in the 90% threshold centres.

Oxygen saturation targets for children with respiratory distress: a systematic review

“…The search strategy yielded 3322 results, including 125 duplicates. After screening and selection, 7 studies were included: 5 RCTs and 2 observational studies (see Figure 1) [15][16][17][18][19][20][21]. Three studies were performed in paediatric wards [15,17,21], three in emergency departments [16,19,20] and one in a paediatric intensive care unit [18].…”

“…After screening and selection, 7 studies were included: 5 RCTs and 2 observational studies (see Figure 1) [15][16][17][18][19][20][21]. Three studies were performed in paediatric wards [15,17,21], three in emergency departments [16,19,20] and one in a paediatric intensive care unit [18]. SpO2 thresholds varied from 80% to 94% or 'liberal' and populations varied across studies.…”

“…Four studies have investigated the impact of S pO 2 thresholds on the length of hospital stay in different patient populations [ 17 , 18 , 20 , 21 ]. In C unningham et al .…”

“…Four studies have investigated the impact of SpO2 thresholds on the length of hospital stay in different patient populations [17,18,20,21]. In Cunningham 2015 the median difference in length of stay was 10 hours (40.9 hours vs 50.9 hours in the 90% and 94% groups, respectively) [17].…”

“…Cunningham 2012, an observational study in children with bronchiolitis found that these children reached a stable SpO2 of greater than 90% 22 hours sooner than reaching a stable SpO2 of greater than 94% [15]. Van Hasselt 2020, a subsequent observational study in bronchiolitis patients compared the length of stay between centres with a 90% threshold and a 92% threshold and found that patients in the 90% threshold centres were discharged significantly earlier, compared to patients in the centres using the 92% threshold, (median of 41 hours vs 59 hours) [20]. Maitland 2021 found that pneumonia patients up to 12 years in the 80% arm had a 0.62 day shorter length of stay (95%CI 0.53 -1.59) than patients in the 92% arm [21].…”