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Intermittent versus continuous oxygen saturation monitoring for infants hospitalised with bronchiolitis: study
Sanjay Mahant1,2, Gita Wahi3, Lucy Giglia3
1Division of Paediatric Medicine, Paediatric Outcomes Research Team (PORT), Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Insights
This study compares intermittent versus continuous pulse oximetry for infants hospitalized with bronchiolitis. It aims to determine the optimal monitoring strategy to reduce hospital stay and improve patient outcomes.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Trials
Background:
- Bronchiolitis is a leading cause of infant hospitalization, primarily managed with supportive care.
- Pulse oximetry monitoring (intermittent vs. continuous) is standard for hypoxia detection.
- Observational data suggest continuous monitoring may prolong hospital stays in stable infants.
Purpose of the Study:
- To compare the effectiveness of intermittent versus continuous pulse oximetry monitoring in infants hospitalized with bronchiolitis.
- To evaluate the impact of monitoring strategies on length of hospital stay and other patient-relevant outcomes.
- To provide evidence-based guidance for optimizing pulse oximetry use in pediatric respiratory infections.
Main Methods:
- A multicenter, pragmatic randomized controlled trial involving infants aged 1 month to 2 years.
- Participants randomized to intermittent or continuous oxygen saturation monitoring post-stabilization.
- Primary outcome: length of hospital stay; secondary outcomes: effectiveness, safety, and cost.
Main Results:
- The study is designed to enroll 210 infants to detect a 12-hour difference in length of stay.
- Statistical power of 90% with a 5% type 1 error rate.
- Results will inform clinical practice regarding pulse oximetry in bronchiolitis.
Conclusions:
- High-quality evidence is lacking to guide pulse oximetry monitoring strategies in infants with bronchiolitis.
- This trial will provide crucial data to optimize care and resource utilization.
- Findings will be disseminated through publications and professional forums.
Introduction:
Bronchiolitis is the most common reason for hospitalisation in infants in developed countries. The main focus of hospital care is on supportive care, such as monitoring for hypoxia and supplemental oxygen administration, as active therapies lack effectiveness. Pulse oximetry is used to monitor hypoxia in hospitalised infants and is used either intermittently or continuously. Observational studies have suggested that continuous pulse oximetry use leads to a longer length of hospital stay in stable infants. The use of continuous pulse oximetry may lead to unnecessary clinical intervention due to readings that are of little clinical significance, false-positive readings and less reliance on the clinical status. There is a lack of high-quality evidence to guide which pulse oximetry monitoring strategy, intermittent or continuous, is superior in infants hospitalised with bronchiolitis with respect to patient and policy-relevant outcomes.
Methods And Analysis:
This is a multicentre, pragmatic randomised controlled trial comparing two strategies for pulse oximetry monitoring in infants hospitalised for bronchiolitis. Infants aged 1 month to 2 years presenting to Canadian tertiary and community hospitals will be randomised after stabilisation to receive either intermittent or continuous oxygen saturation monitoring on the inpatient unit until discharge. The primary outcome is length of hospital stay. Secondary outcomes include additional measures of effectiveness, acceptability, safety and cost. We will need to enrol 210 infants in order to detect a 12-hour difference in length of stay with a type 1 error rate of 5% and a power of 90%.
Ethics And Dissemination:
Research ethics approval has been obtained for this trial. This trial will provide data to guide hospitals and clinicians on the optimal pulse oximetry monitoring strategy in infants hospitalised with bronchiolitis. We will disseminate the findings of this study through peer-reviewed publication, professional societies and meetings.
Trial Registration Number:
NCT02947204.
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