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Home oxygen supplementation reduces admissions for bronchiolitis

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Infants seen in the emergency department with uncomplicated bronchiolitis can be safely managed with oxygen therapy at home, a Colorado team reports in Pediatrics online February 13.

“This study shows that home oxygen is a safe and effective way to decrease hospital admissions in a select group of patients,” conclude Dr. Sarah Halstead and colleagues at the University of Colorado at Denver.

They note that bronchiolitis in young children accounts for more than 150,000 hospital admissions annually in the US.

In a move to reduce admission rates, their institution introduced a home oxygen protocol for children between 1 and 18 months with hypoxia defined as room-air pulse oximetry of <88% and uncomplicated bronchiolitis; ie, “a lower respiratory tract illness associated with wheezing and/or crackles in an otherwise healthy, well-appearing patient without evidence of underlying cardiopulmonary disease.”

To assess the impact of the protocol, the team conducted a chart review of 4194 instances of bronchiolitis seen in the pediatric emergency department. The mean age of the patients was 7.6 months. Of this cohort, 28% were admitted, 15% were discharged on home supplemental oxygen at a mean of 0.39 L/minute, and 57% were discharged on room air.

Readmission rates, usually for increased O2 requirement or increased work of breathing, were 6% in the home oxygen group and 4% among those discharged on room air, according to the report. Among those initially discharged on oxygen, there were no ICU admissions and no need for CPAP, biphasic PAP or endotracheal intubation.

Dr. Halstead and colleagues note that their historical admission rate for bronchiolitis was 40%, and this dropped to 31% with implementation of the home oxygen protocol.

They also point out that their study was conducted at an altitude of 1600 meters, and “we recommend that this study be repeated in a well-controlled setting at sea level.”

SOURCE:

Discharged on Supplemental Oxygen From an Emergency Department in Patients With Bronchiolitis

Pediatrics 2012;129