This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Schroeder, A. R. Articles by Newman, T. B. Search for Related Content PubMed PubMed Citation Articles by Schroeder, A. R. Articles by Newman, T. B. Social Bookmarking                         What's this?

PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1463

Pulse Oximetry in Bronchiolitis Patients

Alan R. Schroeder, MD
Andrea Marmor, MD
Thomas B. Newman, MD, MPH
Division of General Pediatrics
University of California, San Francisco
San Francisco, CA 94143-0503, USA

To the Editor.—

We were pleased to see the article by Mallory et al¹ examining how pulse oximetry readings affect practitioners’ decisions to admit infants with bronchiolitis. Their finding that an oxygen saturation difference of 2% had a significant impact on admission decisions came as no surprise. Oxygen saturation seems to have emerged as a leading criterion not only for hospitalization but also for discharge. It is unfortunate that we have so little evidence to guide decisions on how the oxygen saturation should be used.

Despite the fact that pulse oximetry has become "the fifth vital sign,"² interpreting saturations is not always easy, particularly in the setting of bronchiolitis. In the recent pediatric literature, suggested guidelines for lower limits of acceptable oxygen saturation for bronchiolitis include 90%,^3,4 92%,⁵ and 94%,⁶ but none of these numbers appears to be evidence-based. To further complicate matters, healthy young infants are known to have brief yet frequent desaturations to <90% while sleeping.⁷ However, these guidelines do not provide any recommendations regarding acceptable duration of desaturation or specification of sleep/wake status. Thus, interpretation of pulse oximeter readings is not straightforward and undoubtedly leads to practice variation.

Mallory et al¹ make the argument that the increase in bronchiolitis admission rates over the past 2 decades is attributable in part to increasing pulse oximetry use, and their point is hard to contest. The important next step is to determine whether we are doing these infants a favor or a disservice by placing such an emphasis on oxygen saturation. Developing a more evidence-based approach to bronchiolitis management will require addressing the following questions: 1) How much oxygen delivery is sufficient for cerebral oxygenation and metabolism? 2) Under what circumstances can oxygen be given safely at home? 3) Does use of pulse oximetry improve outcome? 4) If so, how is outcome affected by use of different oxygen saturation thresholds for admission and discharge decisions? Given the high incidence of bronchiolitis hospitalizations and the resultant toll on our health care system, these questions should be a high priority.

REFERENCES

1. Mallory MD, Shay DK, Garrett J, Bordley WC. Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics.2003; 111:(1) . Available at: http://www.pediatrics.org/cgi/content/full/111/1/e45
2. Mower WR, Sachs C, Nicklin EL, Baraff LJ. Pulse oximetry as a fifth pediatric vital sign. Pediatrics.1997; 99 :681 –686[Abstract/Free Full Text]
3. Harrison AM, Boeing NM, Domachowske JB, Piedmonte MR, Kanter RK. Effect of RSV bronchiolitis practice guidelines on resource utilization. Clin Pediatr (Phila).2001; 40 :489 –495[Abstract/Free Full Text]
4. Kotagal UR, Robbins JM, Kini NM, Schoettker PJ, Atherton HD, Kirschbaum MS. Impact of a bronchiolitis guideline: a multisite demonstration project. Chest.2002; 121 :1789 –1797[Abstract/Free Full Text]
5. Rodriguez WJ. Management strategies for respiratory syncytial virus infections in infants. J Pediatr.1999; 135(2, pt 2) :45 –50[Medline]
6. Adcock PM, Sanders CL, Marshall GS. Standardizing the care of bronchiolitis. Arch Pediatr Adolesc Med.1998; 152 :739 –744[Abstract/Free Full Text]
7. Hunt CE, Corwin MJ, Lister G, et al. Longitudinal assessment of hemoglobin oxygen saturation in healthy infants during the first 6 months of age. Collaborative Home Infant Monitoring Evaluation (CHIME) Study Group. J Pediatr.1999; 135 :580 –586[CrossRef][Web of Science][Medline]

---

PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Schroeder, A. R. Articles by Newman, T. B. Search for Related Content PubMed PubMed Citation Articles by Schroeder, A. R. Articles by Newman, T. B. Social Bookmarking                         What's this?