A Randomized Trial of Home Oxygen Therapy From the Emergency Department for Acute Bronchiolitis

Bajaj, Lalit; Turner, Carol G; Bothner, Joan

doi:10.1542/peds.2005-1322

Cited by 67 publications

(73 citation statements)

References 22 publications

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“…With this anatomy, even a small increase in tidal volume after application of PSE can reduce shrinkage and effectively reduce the score in the group in which this technique is applied. Retractions in infants with bronchiolitis are one of the most important clinical signs, and they have been the primary outcome in numerous studies 39,40 . There is no doubt that the reduction of this parameter deserves more attention.…”

Section: Discussionmentioning

confidence: 99%

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Gomes¹,

Postiaux²,

Medeiros³

et al. 2012

Rev. bras. fisioter.

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Objective: To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). Methods: Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 -new Chest Physical therapy-nCPT (Prolonged slow expiration -PSE and Clearance rhinopharyngeal retrograde -CRR), G2 -conventional Chest Physical therapy-cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 -aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). Results:The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). Conclusion: The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.Trial Registration NCT00884429-www.clinicaltrials.gov.Keywords: respiratory suncytial virus; bronchiolitis; physical therapy. ResumoObjetivo: Avaliar a efetividade da fisioterapia respiratória na redução do escore clínico em lactentes com bronquiolite viral aguda (BVA). Métodos: Ensaio controlado randomizado de 30 lactentes (média de idade 4,08±3,12 meses) com BVA, previamente hígidos, com vírus sincicial respiratório (VSR) positivo, avaliados em três momentos: admissão, 48 e 72 horas, antes e após os procedimentos por avaliadores cegos, em três grupos: G1 -técnicas atuais de fisioterapia (expiração lenta e prolongada e desobstrução rinofaríngea retrógrada), G2 -técnicas convencionais de fisioterapia (drenagem postural modificada, compressão expiratória, vibração e percussão) e G3 -aspiração de vias aéreas superiores por meio do escore clínico de Wang e seus componentes: retrações (RE), frequência respiratória (RR), sibilos (WH) e condições gerais (GC). Resultados: O escore clínico de Wang (CS) no momento admissão, no G1, reduziu de 7,0-4,0; no G2, de 7,5-5,5 e no G3 de 7,5-7,0, não apresentando alteração. No momento 48 horas, também houve alteração tanto no G1 (5,5-3,0) quanto no G2 (4,0-2,0) e, em 72 horas, apenas no G1 (2,0-1,0). Conclusão: A fisioterapia respiratória foi efetiva na redução do escore clínico em lactentes com BVA quando comparada com a aspiração isolada das vias aéreas na admissão. No momento 48 horas, ambas as técnicas foram efetivas, sendo que as técnicas atuais foram efetivas também nas 72 horas após a internação, comparada às técnicas convencionais.Registro de Ensa...

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Section: Discussionmentioning

confidence: 99%

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Gomes¹,

Postiaux²,

Medeiros³

et al. 2012

Rev. bras. fisioter.

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“…[1][2][3][4] Hypoxia complicates 70% to 84% of bronchiolitis admissions, prolonging hospital stay by 1.6 days and representing the leading barrier to discharge. [5][6][7] Small changes in oxygen level have a significant impact on decisions to admit, suggesting that pulse oximetry could drive increased admissions in the face of stable mortality rates.…”

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confidence: 99%

“…This practice has been associated with reduced admission rates, lower hospital cost, and high parental satisfaction. 1,2,4 Children discharged on oxygen are typically seen within 24 hours at an outpatient clinic, an established respiratory care center, or an ED. 1,4 Still, outpatient management of home oxygen is variable and there is little information on expected course.…”

mentioning

confidence: 99%

“…1,2,4 Children discharged on oxygen are typically seen within 24 hours at an outpatient clinic, an established respiratory care center, or an ED. 1,4 Still, outpatient management of home oxygen is variable and there is little information on expected course. 11 Although previous studies have evaluated length of oxygen therapy by survey, none have directly reviewed outpatient records associated with oxygen use.…”

mentioning

confidence: 99%

“…11 Although previous studies have evaluated length of oxygen therapy by survey, none have directly reviewed outpatient records associated with oxygen use. 1,11 Furthermore, a small percentage of discharged children require subsequent admission, and although previous work has examined the overall safety of home oxygen therapy, there are few data on factors associated with subsequent hospitalization. 1,2,4 In this context, we aimed to define the outpatient course of children on oxygen for bronchiolitis and identify characteristics associated with subsequent admission.…”

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confidence: 99%

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

et al. 2014

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BACKGROUND: Home oxygen has been incorporated into the emergency department management of bronchiolitis in high-altitude settings. However, the outpatient course on oxygen therapy and factors associated with subsequent admission have not been fully defined. METHODS: We conducted a retrospective cohort study in consecutive patients discharged on home oxygen from the pediatric emergency department at Denver Health Medical Center from 2003 to 2009. The integration of inpatient and outpatient care at our study institution allowed comprehensive assessment of follow-up rates, outpatient visits, time on oxygen, and subsequent admission. Admitted and nonadmitted patients were compared by using a χ2 test and multivariable logistic regression. RESULTS: We identified 234 unique visits with adequate follow-up for inclusion. The median age was 10 months (interquartile range [IQR]: 7–14 months). Eighty-three percent of patients were followed up within 24 hours and 94% within 48 hours. The median length of oxygen use was 6 days (IQR: 4–9 days), and the median number of associated encounters was 3 (range: 0–9; IQR: 2–3). Ninety-three percent of patients were on room air at 14 days. Twenty-two patients (9.4%) required subsequent admission. Fever at the initial visit (>38.0°C) was associated with admission (P < .02) but had a positive predictive value of 15.4%. Age, prematurity, respiratory rate, oxygen saturation, and history of previous bronchiolitis or wheeze were not associated with admission. CONCLUSIONS: There is a significant outpatient burden associated with home oxygen use. Although fever was associated with admission, we were unable to identify predictors that could modify current protocols.

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Decreasing Hospital Length of Stay for Bronchiolitis by Using an Observation Unit and Home Oxygen Therapy

Sandweiss¹,

Mundorff²,

Hill³

et al. 2013

JAMA Pediatr

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A Randomized Trial of Home Oxygen Therapy From the Emergency Department for Acute Bronchiolitis

Abstract: Discharge from the ED on home oxygen after a period of observation is an option for patients with acute bronchiolitis. Secondary to the low incidence of complications, the safety of this practice will require a larger study.

Cited by 67 publications

References 22 publications

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

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

Decreasing Hospital Length of Stay for Bronchiolitis by Using an Observation Unit and Home Oxygen Therapy

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