Experts and practitioners postulate that continuous measurement of oxygen saturation, results in greater detection of transient and false-positive desaturations, leading to unnecessary additional supplemental oxygen use, more interventions, prolonged hospital stays, and higher costs. However, the Choosing Wisely campaign recommends not to use continuous monitoring in infants with bronchiolitis but without hypoxia. There is a low level of evidence and substantial practice variation regarding the use of intermittent or continuous monitoring in infants hospitalized with bronchiolitis. Therefore, researchers of Canada conducted a study to compare the effect of intermittent vs continuous pulse oximetry on clinical outcomes.

It was a multicenter, pragmatic randomized clinical trial that included 229 infants of 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. Among 229 infants, researchers randomized 114 in the intermittent pulse oximetry group, and 115 in the continuous pulse oximetry group with an oxygen saturation target of 90% or higher. The major outcome assessed was the length of hospital stay from randomization to discharge. Researchers also evaluated the 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.

Key findings of the study were:

♦ Upon analysis, researchers found no significant differences between the intermittent and continuous groups in:

• The median length of stay from inpatient unit admission to discharge: 49.1 hours vs 46.0 hours,
• Frequencies or durations of hospital interventions, such as oxygen supplementation initiation: 4 of 114 (3.5%) vs 9 of 115 (7.8%) and the median duration of oxygen supplementation: 20.6 hours vs 21.4 hours.

♦ They also found no significant differences in the

• Frequencies of intensive care unit transfer: 1 of 114 vs 2 of 115 (2.7%);
• Readmission to hospital: 3 of 114 (2.6%) in the intermittent group vs 4 of 115 (3.5%) in the continuous group;
• Parent anxiety: mean (SD) parent anxiety score, 2.9 (0.9) in the intermittent group vs 2.8 (0.9) in the continuous group; or
• Parent workdays missed: median workdays missed, 1.5 vs 1.5days

♦ Additionally, they also found that nursing satisfaction with monitoring was significantly greater in the intermittent group: 8.6 (1.7) vs 7.1 (2.8) of 10 workdays with the mean difference of 1.5.

The authors concluded, "among infants hospitalized with stabilized bronchiolitis with and without hypoxia and managed using an oxygen saturation target of 90% or higher, clinical outcomes, including the length of hospital stay and safety, were similar with intermittent vs continuous pulse oximetry."

They further added, "Nursing satisfaction was greater with intermittent monitoring. Given that other important clinical practice considerations favour less intense monitoring, these findings support the standard use of intermittent pulse oximetry in stable infants hospitalized with bronchiolitis."

For further information:

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2776775