Bronchiolitis Clinical Pathway, Inpatient – Updated Monitoring Guidance

Bronchiolitis Clinical Pathway — Inpatient

What do the national guidelines say about the use of continuous pulse oximetry in bronchiolitis?

  • Do not initiate continuous pulse oximetry in kids with bronchiolitis if they are not receiving supplemental oxygen or flow. Instead, do spot checks of the pulse ox every 2-4 hours.
  • For kids with bronchiolitis who require supplemental oxygen/flow/HFNC, once their respiratory support is discontinued, rapidly transition them from continuous to intermittent pulse oximetry spot checks within 1 hr of weaning to room air as long as the SpO2 remains at 90% or higher during that hour

Reference

Cardiorespiratory and Pulse Oximetry Monitoring in Hospitalized Children: A Delphi Process  

Why are pulse oximetry spot checks preferred over continuous pulse oximetry monitoring for kids not requiring any supplemental oxygen/flow/HFNC?

  • < 2% of pulse oximetry alarms on pediatric wards are actionable, contributing to alarm fatigue and the patient safety risk of nurses missing a valid, important alarm.1,2
  • Every hour of excess continuous monitoring of bronchiolitis patients off oxygen adds an average of 7 unnecessary alarms, which increase nurse workload and distract them from other important care.2,3
  • Some studies have shown continuous pulse oximetry use in stable patients with bronchiolitis may contribute to longer length of stay, more treatment with supplemental oxygen, or higher hospital costs without improving outcomes.4,5,6
  • Adverse events (IV infiltrates, med errors, infection) occur in as many as 1 in 10 admissions for bronchiolitis, and the risk increases with every excess day spent in the hospital.7

References

  1. Association Between Exposure to Non-actionable Physiologic Monitor Alarms and Response Time in a Children's Hospital  
  2. The Alarm Burden of Excess Continuous Pulse Oximetry Monitoring Among Patients With Bronchiolitis  
  3. Physiologic Monitor Alarm Burden and Nurses' Subjective Workload in a Children's Hospital  
  4. Impact of Pulse Oximetry and Oxygen Therapy on Length of Stay in Bronchiolitis Hospitalizations  
  5. Observational Study of Two Oxygen Saturation Targets for Discharge in Bronchiolitis  
  6. Oxygen Saturation Targets in Infants with Bronchiolitis (BIDS): a Double-blind, Randomised, Equivalence Trial  
  7. Preventable Adverse Events in Infants Hospitalized With Bronchiolitis