What is the efficacy of continuous pulse oximetry (pulse ox) for bronchiolitis management?

From the Guidelines

Continuous pulse oximetry is not recommended for routine use in bronchiolitis management.

Rationale

• The evidence suggests that pulse oximetry has been rapidly adopted into clinical assessment of children with bronchiolitis, but few studies have assessed its effectiveness in predicting clinical outcomes 1.
• Among inpatients, perceived need for supplemental oxygen based on pulse oximetry has been associated with prolonged hospitalization, ICU admission, and mechanical ventilation, but this may not be due to the pulse oximetry itself 1.
• The accuracy of pulse oximetry is poor, especially in the 76% to 90% range, and it has been erroneously used as a proxy for respiratory distress 1.
• Transient desaturation is a normal phenomenon in healthy infants, and continuous pulse oximetry measurement may lead to unnecessarily prolonged hospitalization and increased risk of minor adverse events 1.
• The benefits of continuous pulse oximetry do not outweigh the harms, and it is recommended to use it only when necessary, such as in cases of severe respiratory distress or underlying conditions that may affect oxygenation 1.

Key Points

• Pulse oximetry should not be used as a sole indicator for hospitalization or oxygen therapy 1.
• Clinical signs and symptoms, such as respiratory rate, retractions, and feeding difficulties, should be used to assess the severity of bronchiolitis 1.
• The oxyhemoglobin dissociation curve shows that small increases in arterial partial pressure of oxygen are associated with marked improvement in pulse oxygen saturation when it is less than 90%, but this may not result in clinically significant differences in physiologic function, patient symptoms, or clinical outcomes 1.
• The risk of hypoxemia must be weighed against the risk of hospitalization when making decisions about site of care, and supplemental oxygen should be provided only when necessary 1.

From the Research

Efficacy of Continuous Pulse Oximetry for Bronchiolitis Management

The efficacy of continuous pulse oximetry (pulse ox) for bronchiolitis management is a topic of ongoing research and debate. Several studies have investigated the use of continuous pulse oximetry in infants and children hospitalized with bronchiolitis.

Key Findings

• A study published in 2018 2 found that there is a lack of high-quality evidence to guide the use of pulse oximetry monitoring in infants hospitalized with bronchiolitis, and that continuous pulse oximetry may lead to unnecessary clinical intervention due to readings that are of little clinical significance.
• A qualitative analysis of clinicians' justifications for continuous pulse oximetry monitoring in children hospitalized with bronchiolitis found that 70% of responses did not include a clinical reason for monitoring 3.
• A cross-sectional study published in 2024 4 found that the use of continuous pulse oximetry in infants with bronchiolitis was associated with more investigations and interventions, and a higher rate of admission to the hospital.
• A quality improvement initiative published in 2019 5 found that reducing the use of continuous pulse oximetry in stable infants with non-severe bronchiolitis was associated with a decrease in length of stay in the hospital.
• A qualitative study published in 2021 6 identified barriers and facilitators to guideline-adherent pulse oximetry use in bronchiolitis, including leadership buy-in, clear authoritative guidelines, and regular education about pulse oximetry use.

Implications for Practice

• The use of continuous pulse oximetry in infants and children hospitalized with bronchiolitis should be guided by clear protocols and guidelines 2, 6.
• Clinicians should be aware of the potential for unnecessary clinical intervention due to readings that are of little clinical significance 2, 3.
• Reducing the use of continuous pulse oximetry in stable infants with non-severe bronchiolitis may be associated with a decrease in length of stay in the hospital 5.
• Education and leadership buy-in are important factors in reducing the overuse of continuous pulse oximetry in bronchiolitis 6.