COMMENTARY

Send Kids With Bronchiolitis Home on O2?

William T. Basco, Jr., MD, MS

Disclosures

September 17, 2014

Outpatient Course and Complications Associated With Home Oxygen Therapy for Mild Bronchiolitis

Flett KB, Breslin K, Braun PA, Hambridge SJ
Pediatrics. 2014;133:769-775

Study Summary

Evidence suggests that hypoxia in a child with bronchiolitis can prolong inpatient hospitalization by one or more days. This study was conducted in Denver, Colorado, where high altitude increases the prevalence of hypoxemia, and 37% of children with bronchiolitis required oxygen in the emergency department (ED). This retrospective evaluation looked at outcomes among children who were managed with home oxygen therapy, with the intention of identifying factors at ED presentation that would suggest which patients are good candidates for home oxygen therapy.

Patients were treated in pediatric EDs and outpatient settings in 2003 through 2009. In 2003, the healthcare system overseeing these sites instituted a protocol outlining criteria for which children could be discharged from the ED on home oxygen. These included age from 2 months to 2 years, a first-time episode of wheezing, and a presentation during the peak of bronchiolitis season. Other requirements were: secretions manageable by bulb suctioning alone, a return to a smoke-free environment at an altitude of ≤ 6000 ft, and a reliable ability to return for medical care. Children who appeared very ill, had experienced an apparent life-threatening event, had chronic medical conditions or baseline oxygen requirements, or had an immunodeficiency were excluded. The children were observed for at least four hours and had to feed well, have a respiratory rate of < 50 breaths/min, and have oxygen saturations of at least 90% on no more than one half-liter of oxygen by nasal cannula. Children who met all of these criteria could be discharged on home oxygen. They were all instructed to be seen by their primary care provider or the ED within 24 hours.

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