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Observational study of two oxygen saturation targets for discharge in bronchiolitis
Steve Cunningham1, Ann McMurray
1Department of Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, UK. steve.cunningham@nhs.net
Insights
Discharging infants with bronchiolitis at a lower oxygen saturation (SpO2) of 90% could shorten hospital stays. Further studies are needed to confirm the clinical and safety effects of this approach.
Area of Science:
- Pediatric Respiratory Medicine
- Neonatal Care
- Clinical Trial Design
Background:
- Bronchiolitis is a common respiratory infection in infants.
- Current guidelines recommend specific discharge oxygen saturation (SpO2) levels for recovering infants.
- The optimal SpO2 threshold for safe and timely discharge remains under investigation.
Purpose of the Study:
- To compare the clinical outcomes of two different discharge oxygen saturation (SpO2) recommendations (≥90% vs. ≥94%) in infants recovering from bronchiolitis.
- To assess the impact of discharge SpO2 targets on length of hospital stay and feeding recovery.
Main Methods:
- A study involving 68 infants (up to 18 months) requiring therapeutic oxygen for SpO2 ≤93%.
- Oxygen saturation (SpO2) was monitored every 2 hours.
- Time to re-establish feeding and achieve stable SpO2 (≥90% and ≥94%) were recorded.
Main Results:
- Infants achieved a stable SpO2 ≥90% significantly faster than ≥94%.
- The median time to achieve stable SpO2 ≥90% and resolve feeding difficulties was 22 hours sooner compared to the ≥94% target.
- Feeding problems resolved at a median of 11 hours.
Conclusions:
- Lowering the discharge oxygen saturation (SpO2) threshold to ≥90% may reduce length of stay for infants with bronchiolitis.
- Clinical and safety implications of accepting lower SpO2 levels at discharge require further investigation.
- This finding suggests a potential strategy for optimizing resource utilization in pediatric respiratory care.
Objectives:
To assess the potential effect of two guideline discharge oxygen saturation (SpO(2)) recommendations (≥90% and ≥94%) in recovering bronchiolitis.
Methods And Patients:
Infants aged up to 18 months requiring therapeutic oxygen for SpO(2) (≤93%) had SpO(2) assessed in air every 2 h. Time from admission to re-establish feeding (>75% normal) and for SpO(2) to become stable for at least 4 h at ≥90% and ≥94% were noted.
Results:
68 infants, median age 14 weeks, were included. Feeding problems resolved at a median of 11 h (inter-quartile range, IQR 0-47). SpO(2) became stable for at least 4 h at 17 h (IQR 0-49) for ≥90% and 63 h (IQR 34-105) for ≥94%. Time for infants to achieve a stable SpO(2)≥90% and resolve feeding difficulties was a median of 22 h (IQR 7-39 h) sooner than the equivalent for stable SpO(2)≥94%.
Conclusions:
Accepting lower SpO(2) at discharge could significantly reduce length of stay, but require the clinical and safety effects to be studied.
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