Intermittent vs Continuous Pulse Oximetry for Bronchiolitis Hospitalizations: A Systematic Review

The decision to use pulse oximetry continuously or intermittently for patients admitted to the hospital with bronchiolitis varies among providers and institutions.

To systematically review the effectiveness, safety, and cost-effectiveness of intermittent vs continuous pulse oximetry monitoring in children hospitalized with bronchiolitis.

The PubMed, EMBASE, CINAHL, Scopus, and Web of Science databases were searched until December 13, 2024.

Studies of children younger than 2 years admitted with bronchiolitis that reported outcomes of continuous and intermittent pulse oximetry were included.

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.

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.

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.