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Intermittent vs Continuous Pulse Oximetry for Bronchiolitis Hospitalizations: A Systematic Review
Katherine Salada1,2, Jodi Ehrmann1,2, Kate M Saylor3
1Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
Insights
For hospitalized infants with bronchiolitis, intermittent pulse oximetry monitoring is as effective and safe as continuous monitoring. This approach offers similar length of stay and oxygen use without compromising patient safety or increasing costs.
Area of Science:
- Pediatric hospital medicine
- Respiratory illness management
- Medical device utilization
Background:
- The choice between continuous and intermittent pulse oximetry for hospitalized bronchiolitis patients lacks consistent guidelines.
- Variability in monitoring practices necessitates a review of evidence-based recommendations.
Purpose of the Study:
- To systematically review the effectiveness, safety, and cost-effectiveness of intermittent versus continuous pulse oximetry in children hospitalized with bronchiolitis.
- To inform clinical decision-making regarding optimal monitoring strategies for this patient population.
Main Methods:
- A comprehensive search of major biomedical databases (PubMed, EMBASE, CINAHL, Scopus, Web of Science) was conducted.
- Included studies focused on children under two years old with bronchiolitis, comparing continuous and intermittent pulse oximetry outcomes.
- Due to study heterogeneity, a synthesis without meta-analysis was performed.
Main Results:
- Randomized controlled trials (RCTs) involving 390 children showed similar length of stay (LOS) and supplemental oxygen duration between intermittent and continuous monitoring.
- No increased intensive care unit (ICU) transfer rates were observed with intermittent monitoring.
- Economic evaluations indicated comparable healthcare costs, while some studies noted increased alarm burden and parental anxiety with continuous monitoring.
Conclusions:
- Intermittent and continuous pulse oximetry monitoring demonstrate similar effectiveness, safety, and cost-effectiveness in hospitalized children with bronchiolitis.
- Evidence from RCTs supports the use of intermittent monitoring as a viable alternative to continuous monitoring.
- Further research may explore parental experience and alarm fatigue associated with continuous monitoring.
Context:
The decision to use pulse oximetry continuously or intermittently for patients admitted to the hospital with bronchiolitis varies among providers and institutions.
Objective:
To systematically review the effectiveness, safety, and cost-effectiveness of intermittent vs continuous pulse oximetry monitoring in children hospitalized with bronchiolitis.
Data Sources:
The PubMed, EMBASE, CINAHL, Scopus, and Web of Science databases were searched until December 13, 2024.
Study Selection:
Studies of children younger than 2 years admitted with bronchiolitis that reported outcomes of continuous and intermittent pulse oximetry were included.
Data Extraction:
Two reviewers independently screened titles, abstracts, and full texts for eligibility. Study characteristics, study quality, and outcomes were extracted from each article. Studies were heterogeneous in design; therefore, a synthesis without meta-analysis was conducted.
Results:
Of 2299 citations identified, 187 were reviewed in full text, and 11 studies included. Two multicenter randomized control trials (RCTs) (n = 390) found that intermittent monitoring had similar length of stay (LOS) and supplemental oxygen duration, without increased intensive care unit transfer rates. One economic evaluation found similar health care and societal costs between monitoring strategies. One cohort study found increased alarm burden with continuous monitoring. Cross-sectional studies reported that continuous monitors were helpful and provided security to parents but were associated with increased parental anxiety and fatigue. Quality improvement studies of bundled interventions found reduced or similar LOS with intermittent monitoring, with no change in readmission rates.
Conclusions:
Based on RCTs, intermittent and continuous pulse oximetry monitoring in hospitalized children with bronchiolitis have similar outcomes of LOS, supplemental oxygen duration, safety, and cost-effectiveness.
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