Home oxygen therapy for bronchiolitis feasible, cost-effective, and favorable to caregivers

1. A systematic review of international literature suggests that home oxygen therapy for bronchiolitis is well-received by parents and caregivers and can reduce hospital costs.

2. Available evidence, though limited, demonstrates low readmission rates and minimal use of intensive care among infants with bronchiolitis treated with home oxygen.

Evidence Rating Level: 2 (Good)

Study Rundown: COVID waves coinciding with seasonal bronchiolitis spikes have demonstrated the demand that respiratory illnesses can place on pediatric hospital systems. Home care models for bronchiolitis could alleviate the hospital burden of this illness. A systematic review of studies published in the last twenty years identified ten which examine the use of home oxygen therapy in the treatment of bronchiolitis. Twenty-five to fifty percent of patients diagnosed with bronchiolitis met the studies’ variable criteria for home oxygen treatment, with 70-82% of those patients successfully discharged to receive care at home.  Safety and patient outcomes were favorable, with a readmission rate of approximately 6% of those patients treated with home oxygen. Two studies assessed caregiver reception of treatment, with a plurality of parent/guardians preferring home treatment to hospitalization. Savings to the health care system were estimated to be approximately $1500-$4000 per patient encounter, with wide variability based on the studied health care system. However, significant study limitations prevent generalizability. No RCTs included in the review were adequately powered, and the highest quality studies all occurred in hospital systems at altitude, making extrapolation to sea-level challenging. Multiple studies included patients aged > 1 year, risking capture of other respiratory conditions besides bronchiolitis in their study population. Despite these limitations, the available body of evidence encourages continued exploration of the home care model for bronchiolitis. Remote monitoring / telemedicine models and at-home nasogastric feeding and rehydration, though understudied, may provide additional avenues of research in the ongoing effort to reduce the burden of bronchiolitis on the pediatric healthcare system.

Click to read the study in PEDIATRICS

Click to read an accompanying editorial in PEDIATRICS

Relevant Reading: Emergency Department–initiated Home Oxygen for Bronchiolitis: A Prospective Study of Community Follow-up, Caregiver Satisfaction, and Outcomes

In-Depth [systematic review]: This systematic review searched across five medical literature databases and screened >1300 studies, identifying 10 that examined infants with bronchiolitis managed with at-home oxygen therapy. The studies included randomized control trials, prospective cohort studies and retrospective chart reviews across the United States, Australia, and Canada. Despite including search terms for at-home nasogastric tube hydration and remote monitoring, no literature examining these interventions were identified that met inclusion criteria. Across all studies, 25-50% of infants with bronchiolitis were eligible for at-home treatment with 70-82% discharged with home oxygen therapy. One study noted a 68% success rate with at-home treatment. Readmission rates ranged from 2.4% to 9.4% (n=79 of 1257 in the pooled population across five studies), with no significant difference in populations at higher altitudes when compared to those at sea level. Only three patients in this cohort required escalation to intensive care, with one requiring intubation. Two studies assessed caregiver satisfaction, with preference for home oxygen therapy over hospitalization ranging from 79-88% across studies. Cost analysis varied widely by system, but savings estimates per encounter ranged from $1200-$4100 across studies, with no studies commenting on familial or societal savings. Study bias was assessed using the Quality Assessment with Diverse Studies guidelines. Both RCTs were noted to be underpowered; two large population studies were confounded with the simultaneous use of an observational unit and home oxygen therapy model. Several studies were noted to have variation in the ages and characteristics of their populations.

Image: PD

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