Assessment of Continuous Pulse Oximetry Monitoring in Infants With Bronchiolitis in the Pediatric Emergency Department: A Cross-Sectional Study

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.