Pulse oximetry in bronchiolitis: is it needed?

Abstract

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.

Comparison of Kristjansson Respiratory Score and Wang Respiratory Score in infants with bronchiolitis in a hospital emergency department

“…The SpO 2 determined by pulse oximeter is usually used by physicians to establish bronchiolitis severity, but should be considered alongside other factors such as respiratory frequency, heart rate, age and feeding intake to get the most accurate assessment of bronchiolitis level of severity. 3 , 21 , 22 The average negative correlation between SpO 2 and both respiratory scores obtained in our study was similar to that reported by Chin and Seng. 14 The fair correlation could not be seen as a negative outcome because a large fluctuation of SpO 2 is normal during a bronchiolitis episode and it is normal to observe low levels of SpO 2 in light or moderate bronchiolitis.…”

Australasian bronchiolitis guideline

“…Studies have predominantly investigated the duration of oxygen administration and feeding difficulties as a gauge of effectiveness . There is no evidence of the benefit of oxygen in children without hypoxia and low‐level evidence that maintaining an oxygen saturation of more than 91% prolongs length of stay . The absolute oxygen saturation at which to commence supplemental oxygen therapy has ranged in studies from 90 to 94%.…”

Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis

“… 4 The determination to hospitalize children with bronchiolitis has been vastly impacted by pulse oximetry, in spite of its dubious diagnostic importance in delineating the severity of the illness. 5 A large number of clinicians have deficits in the clinical fundamentals and constraints of pulse oximetry, 4 , 6 and their judgments to hospitalize the infant might be based on only a 2% difference in oxygen saturation. 7 Although it leads to feeble prognostication of respiratory distress, oxygen saturation is associated strongly with an increased proportion of hospitalization of young children with acute bronchiolitis 8 and an influence on hospital length of stay.…”