Continuous Versus Intermittent Pulse Oximetry Monitoring of Children Hospitalized for Bronchiolitis

Sunday, October 27, 2013
Regency Ballroom S (Hyatt Regency Orlando, formerly the Peabody)


Purpose:  Bronchiolitis is the most common infectious cause of pediatric hospitalization. Hypoxia is a common reason for admission for bronchiolitis. However, pulse oximetry monitoring recommendations in these children are based on expert opinion.  The purpose of this study is to assess the impact of intermittent pulse oximetry monitoring on length of stay, clinical outcomes, and health care costs for children hospitalized for bronchiolitis.

Methods:  Multi-center, randomized trial of pulse oximetry monitoring strategies for children hospitalized for bronchiolitis. Otherwise healthy children with a history of term birth and hospitalized for bronchiolitis were randomized to continuous pulse oximetry monitoring (control arm) or spot-checks during regular vital sign and clinical reassessments (intervention arm). Researchers collected data on clinical outcomes, length of stay (LOS), number of invasive respiratory treatments performed, diagnostic and therapeutic measures utilized, and costs of care.

Results:  A total of 103 patients have been enrolled out of a goal of 266 patients. Children randomized to intermittent monitoring were significantly older than those undergoing continuous monitoring (6.6 months intermittent vs 3.5 months, p=0.01). Mean LOS was not significantly different between study arms (1.9 days intermittent vs 2.0 days continuous monitoring, p=0.98). Children randomized to intermittent pulse oximetry monitoring had no difference in rate of PICU admission, diagnostic testing, oropharyngeal suctioning, antibiotic use, bronchodilator use, or duration of supplemental oxygen therapy. Average total cost of all diagnostic testing, including pulse oximetry monitoring, was $203.80 for patients receiving continuous monitoring versus $179.80 for patients undergoing intermittent monitoring (p=0.19)

Conclusion:  Our interim analysis demonstrates no safety risk to patients undergoing intermittent pulse oximetry monitoring and a trend toward decreased costs of diagnostic testing and monitoring. Length of stay for hospitalized patients did not change based on pulse oximetry monitoring strategy. These preliminary data support the expert guideline that intermittent pulse oximetry monitoring be used in children hospitalized for bronchiolitis.