Use of Intermittent vs Continuous Pulse Oximetry for Nonhypoxemic Infants and Young Children Hospitalized for Bronchiolitis

Abstract

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

Racial and Ethnic Disparities in Parental Refusal of Consent in a Large, Multisite Pediatric Critical Care Clinical Trial

“…12 Perhaps because of these factors, the RESTORE refusal rate is low compared with other similar pediatric research clinical trials. For example, the RESTORE refusal rate of 23% is better than observed in a trial of pulse oximetry monitoring for bronchiolitis (31%) 16 and markedly better than obtained in a nontherapeutic pediatric ICU cohort study of adrenal insufficiency (58%). 17 However, this low RESTORE refusal rate did not prevent disparities in participation by minority children.…”

When technology creates uncertainty: pulse oximetry and overdiagnosis of hypoxaemia in bronchiolitis

“…22 The authors concluded that intermittent pulse oximetry was safe, in that no differences in escalations of care were seen between groups. Surprisingly, they found no difference in length of stay between groups, perhaps because the intervention was not initiated until children were weaned off oxygen.…”

The Impact of Reduced Pulse Oximetry Use on Alarm Frequency

“…McCulloh and colleagues 16 in a recently published randomized controlled trial found that intermittent (versus continuous) pulse oximetry did not reduce LOS. Our team also failed to demonstrate a reduced LOS coincident with our QI intervention that decreased time on CPOx after clinical improvement.…”