Care of Infants and Children With Bronchiolitis: A Systematic Review

Evidence-Based Protocols to Guide Pulse Oximetry and Oxygen Weaning in Inpatient Children with Asthma and Bronchiolitis: A Pilot Project

“…Moderately ill children need spot check pulse oximetry every 2 to 4 hours with consideration of continuous monitoring if showing signs of instability. Symptoms of severe illness in children necessitate continuous pulse oximetry and regular consideration of the need for transfer to an intensive care (Children's Hospital of Colorado, 2011; Global Initiative for Asthma, 2014;Johnson, 2009;Lieberthal et al, 2006;Royal Children's Hospital, Melbourne, 2011;Scottish Intercollegiate Guidelines Network (SIGN), 2009;Woods, 2013;Zentz, 2011).…”

“…Most experts recommend keeping oxygen saturations at or above 90% (Global Initiative for Asthma, 2014; Lieberthal et al, 2006;Royal Children's Hospital, Melbourne, 2011;Zentz, 2011). Other physician groups provide more conservative guidelines, instructing caregivers to maintain baseline oxygen saturation levels at 92-93% [Children's Hospital of Colorado, 2011; Scottish Intercollegiate Guidelines Network (SIGN), 2009] (Table 1).…”

“…In children with bronchiolitis, there is strong scientific support to maintain SpO 2 at 90% or greater by increasing or decreasing rates of supplemental oxygen based on hourly assessments (Ramsey, 2012;Royal Children's Hospital, Melbourne, 2011;Zentz, 2011). Children with oxygen concentration needs greater than 40-50% require care management in intensive care units (Royal Children's Hospital, Melbourne, 2011).…”

“…Children with oxygen concentration needs greater than 40-50% require care management in intensive care units (Royal Children's Hospital, Melbourne, 2011). Weaning oxygen by protocol includes reducing oxygen according to the patient status and recording observations at least hourly for a couple of hours after weaning oxygen (Royal Children's Hospital, Melbourne, 2011;Zentz, 2011).…”

“…Researchers have hypothesized that the increased use of pulse oximetry since the 1980s has been associated with increased admissions and length of stay because of unclear guidelines about safe SpO 2 levels in children discharged from the hospital, especially in the bronchiolitis population (Shay et al, 1999;Zentz, 2011). Approximately 149,000 children were hospitalized with bronchiolitis in the U.S. in 2002 (Pelletier, Mansbach, & Camargo, 2006).…”