Home oxygen treatment for mild bronchiolitis explored

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1. Age, prematurity, respiratory rate, and oxygen saturation at initial presentation, in addition to history of wheezing/bronchiolitis, were not predictors for hospital admission in pediatric patients being treated with home oxygen for bronchiolitis.

2. Fever at initial presentation was associated with a higher rate of admission, but its low positive predictive value precluded it from being a clinically useful determinant.

Evidence Rating Level: 2 (Good)

Study Rundown: Viral bronchiolitis is an inflammatory condition of the lower airways most often affecting children under the age of 2. Treatment is supportive and oftentimes includes supplemental oxygen until the child can independently maintain adequate oxygen saturations. In place of inpatient management for mild cases, emergency departments (ED) in high altitude settings have developed protocols for home oxygen therapy with close outpatient follow-up. This study assessed admission rates and outpatient course for such patients managed with home oxygen for bronchiolitis. Findings indicate a higher admission rate than that reported in previous literature; however, risk factors for admission remained unclear. All hospitalized patients did well, with none requiring intensive care or positive pressure ventilation. Though with limited results and conducted in a specific high altitude setting, results from this study support home therapy oxygen as a feasible treatment for mild bronchiolitis in patients, provided that protocols exist for solid follow-up care.

Click to read the study published today in Pediatrics

Click to read an accompanying editorial in Pediatrics

Relevant Reading: Discharged on Supplemental Oxygen From an Emergency Department in Patients with Bronchiolitis

In-Depth [retrospective cohort]: This study enrolled 234 patients, aged 0 to 36 months, who were seen at the Denver Health Medical Center from 2003 to 2009. All patients were discharged from the ED with home oxygen for bronchiolitis; 94% of patients followed up with a clinic or ED visit within 48 hours and 83% of enrolled patients seen within 24 hours after initial visit. Twenty-two patients (9.4%) required admission, with no patient deaths, intensive care admissions, or positive pressure ventilation cases reported. The overall cohort stayed on home oxygen for an average of 6 days, with 93% of patients discontinuing supplemental oxygen by 14 days. Though fever at initial visit had a high negative predictive value for admission at 96.6%, its low positive predictive value (15.4%) precluded it from being a clinically useful determinant. No other risk factors (including age, prematurity, respiratory rate, oxygen saturation, history of wheezing, history of bronchiolitis) were identified as predictors for admission in home oxygen therapy for bronchiolitis.

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