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March 1, 2021

Should We Prioritize Deimplementation of Continuous Pulse Oximetry in Bronchiolitis Care?

Author Affiliations
  • 1Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
  • 2Harvard Medicine-Pediatrics Residency Program, Brigham and Women’s Hospital and Boston Children’s Hospital, Boston, Massachusetts
JAMA Pediatr. 2021;175(5):459-461. doi:10.1001/jamapediatrics.2020.6157

Bronchiolitis, an acute viral infection of the lower respiratory tract, is a leading cause of hospitalizations among infants and toddlers.1 The Choosing Wisely campaign and the American Academy of Pediatrics clinical practice guidelines outline an evidence-based, supportive approach to bronchiolitis care, but adoption of these recommendations remains variable.2-4 In particular, a recent cross-sectional study4 of 56 North American hospitals found that guideline-concordant use of continuous pulse oximetry in hospitalized infants with bronchiolitis ranged from 2% to 92%. This variability may stem from the fact that the recommendation is based on evidence from retrospective, nonrandomized studies that found associations between use of continuous pulse oximetry and increased length of stay (LOS), higher costs, and patient harm. It therefore carries the worst evidence-quality grade (D) and weakest recommendation strength of any in the American Academy of Pediatrics guideline.

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    1 Comment for this article
    Ethnographic OPTICS
    Paul Nelson, MS, MD | Family Health Care PC retired
    Within the vast spectrum of pediatric Human Suffering, the social interactions involving a first-born healthy toddler with the sudden onset of "trouble breathing" from bronchiolitis tends to instigate all sorts of unknowns regarding its underlying disruptive process, its precise evaluation, and its susceptibly predictive response to various treatment protocols.
    As a retired med-ped Primary Physician, I still retain vivid memories regarding the family interactions occurring when we stopped using "croup tents". The original study using a radiographically laced nebulizer fluid "told the tale": the mist ended up in the throat and
    stomach but not the lungs. Subsequently, I always suspected that the radiographically laced, nebulizer fluid would no longer represent an acceptable test model. At the time, it fortunately represented "proof" that the croup tent was not necessary. Would that we eventually find a pulmonary function test that is reliably, much better than our 1819 stethoscope.