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Oxygen Saturation Targets in Infants Hospitalized With Bronchiolitis: A Multicenter Cohort Study
James H B Im1,2, Gita Wahi3, Lucy Giglia3
1Dalla Lana School of Public Health.
Insights
Hospital oxygen saturation targets for infants with bronchiolitis showed similar clinical outcomes. Policies of 90% awake/88% asleep or 90% awake/asleep did not significantly differ in patient recovery or resource use.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Outcomes Research
Background:
- Bronchiolitis is a common respiratory infection in infants, often requiring hospitalization.
- Oxygen saturation targets are a key management strategy in hospitalized infants with bronchiolitis.
- Different hospital policies exist regarding target oxygen saturation levels during awake and asleep states.
Purpose of the Study:
- To compare clinical outcomes in infants hospitalized with bronchiolitis under two different hospital oxygen saturation target policies.
- To evaluate the association between oxygen saturation targets (90%/88% vs. 90%/90%) and patient outcomes.
Main Methods:
- A multicenter cohort study utilizing data from a randomized clinical trial.
- Inclusion of infants aged 4 weeks to 24 months hospitalized with bronchiolitis.
- Modeling the association between two oxygen saturation target policies (90% awake/88% asleep vs. 90% awake/asleep) and clinical outcomes.
Main Results:
- No significant differences were observed in time to discharge, supplemental oxygen use, or revisits between the two oxygen saturation target groups.
- Parental work absence showed a trend towards being higher in the 90%/88% group (adjusted odds ratio, 2.41; P = .08).
- Three infants in the 90%/88% group required intensive care unit transfer, compared to none in the 90%/90% group.
Conclusions:
- Hospital oxygen saturation target policies of 90% awake/88% asleep and 90% awake/asleep result in similar clinical outcomes for infants hospitalized with bronchiolitis.
- These findings suggest flexibility in setting oxygen saturation targets for bronchiolitis care.
- Further research may inform optimal oxygen saturation targets in pediatric respiratory care.
Objectives:
To examine 2 hospital oxygen saturation target policies and clinical outcomes in infants hospitalized with bronchiolitis.
Methods:
This multicenter cohort study used data collected from a randomized clinical trial of infants aged 4 weeks to 24 months, hospitalized with bronchiolitis at children's and community hospitals from 2016 to 2019. We modeled the association between hospital oxygen saturation target policy, either 90% while awake and 88% while asleep (90%/88%) or 90% while awake and asleep (90%/90%), and clinical outcomes.
Results:
A total of 162 infants were enrolled at 4 hospitals using a 90%/88% oxygen saturation target and 67 infants at 2 hospitals using a 90%/90% target policy. No significant differences between the 90%/88% group and 90%/90% groups were observed for time to discharge (adjusted hazard ratio, 0.83; 95% confidence interval [CI], 0.61-1.14; P = .25), initiation of supplemental oxygen (adjusted odds ratio [aOR], 0.98; 95% CI, 0.47-2.02; P = .95), time to discontinuation of supplemental oxygen (adjusted hazard ratio, 0.75; 95% CI, 0.44-1.27; P = .28), revisits (aOR, 1.38; 95% CI, 0.52-3.71; P = .52), and parent days missed from work (aOR, 2.41; 95% CI, 0.90-6.41; P = .08). Three infants in the 90%/88% group and none in the 90%/90% group were transferred to the ICU.
Conclusions:
Among infants hospitalized with bronchiolitis, clinical outcomes were similar between a hospital oxygen saturation target policy of 90% while awake and 88% while asleep compared with 90% while awake and asleep. These findings may inform the design of future trials of oxygen saturation targets in bronchiolitis hospital care.
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