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Assessment of Continuous Pulse Oximetry Monitoring in Infants With Bronchiolitis in the Pediatric Emergency
Katie Gardner1, Tiffany Curl1, Katrina F Hurley1
1Emergency Medicine, Izaak Walton Killam (IWK) Health, Halifax, CAN.
Insights
Continuous pulse oximetry is frequently used in infants with bronchiolitis, even when not needed. This practice may lead to more interventions and admissions, suggesting a need for objective guidelines to ensure appropriate use.
Area of Science:
- Pediatrics
- Pulmonology
- Medical Device Utilization
Background:
- Bronchiolitis guidelines advocate for intermittent pulse oximetry in stable infants.
- Continuous pulse oximetry can pose risks and is often overused in emergency departments for infants not requiring oxygen.
- Accurate documentation of continuous pulse oximetry use is challenging.
Purpose of the Study:
- To establish a feasible method for documenting continuous pulse oximetry use in infants with bronchiolitis.
- To investigate factors influencing the application of continuous pulse oximetry in this patient population.
Main Methods:
- A cross-sectional observational study was conducted in a tertiary pediatric emergency department.
- Infants aged 60 days to 12 months with suspected bronchiolitis and no oxygen requirement were observed.
- Direct observation by research assistants documented pulse oximetry monitor usage.
Main Results:
- 33.3% of included infants were placed on continuous pulse oximetry.
- Infants on continuous monitoring underwent more investigations (e.g., chest X-rays, bloodwork) and interventions (e.g., antibiotics, bronchodilators).
- Continuous pulse oximetry use was associated with higher admission rates (66.7% vs. 8.3%).
Conclusions:
- Provider characteristics may influence the decision to use continuous pulse oximetry.
- Objective parameters are needed to guide the use of continuous pulse oximetry and mitigate potential harm.
- Current practices may lead to unnecessary interventions and increased healthcare utilization.
Abstract:
Purpose Bronchiolitis guidelines recommend intermittent pulse oximetry monitoring for stable infants. Continuous pulse oximetry can lead to harm for some infants with bronchiolitis but is still frequently used in emergency departments (EDs) for infants who do not require oxygen supplementation. Measuring continuous pulse oximetry use from medical charts can be challenging. This study aimed to (1) develop a feasible method for documenting the use of continuous pulse oximetry in infants with bronchiolitis and (2) explore factors influencing its use in this population. Methods We conducted a cross-sectional observational study in a tertiary pediatric ED. Infants 60 days and 12 months old with possible bronchiolitis and not requiring oxygen were included. The patients were recruited from January 11 to March 21, 2023. Research assistants directly observed the use of pulse oximetry monitors. The primary outcome was the proportion of infants placed on continuous pulse oximetry. The secondary outcomes included disease severity, admission, unplanned return visits, the use of supplemental oxygen, and the need for investigations and interventions. Results Eighteen infants were included in this study, with six (33.3%) placed on continuous pulse oximetry. The median disease severity score was similar between infants who were continuously monitored (6.5 (IQR 5.3, 10.8)) and those in the intermittent pulse oximetry group (4.5 (IQR 2, 9)). Infants in the continuous pulse oximetry group underwent more investigations and interventions than those in the intermittent pulse oximetry group: chest radiograph and bloodwork in 50% versus 8.3%, antibiotics in 33.3% versus 8.3%, bronchodilators in 33.3% versus 16.7%, and steroids in 16.7% versus 0%. In the continuous pulse oximetry group, four infants (66.7%), all of whom were placed on supplemental oxygen, were admitted, compared to one infant (8.3%) in the intermittent pulse oximetry group. Conclusion The decision to use continuous pulse oximetry may be influenced by provider characteristics. Objective parameters should be developed to guide its application and minimize potential harms associated with it.
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