Rationale Whilst providing oxygen supplementation for an oxygen saturation (SpO2) <90% during acute respiratory illness has been demonstrated to reduce mortality, the effect of supplementing oxygen on recovery for SpO2 ≥90% has not been demonstrated. With no evidence base, UK bronchiolitis guidelines (SIGN 91) recommend maintaining SpO2 ≥ 94%, whilst US guidelines recommend ≥90%. This study tests the effect of supplementing oxygen to a limit of 90% SpO2 on recovery in infants with acute viral bronchiolitis.
Methods We performed a double-blind randomised controlled equivalence study in 8 paediatric hospitals in the UK over two winter 6-month seasons (2011/12, 2012/13). Infants >6 weeks and ≤12 months corrected age were eligible to be randomised if they were diagnosed with bronchiolitis by an emergency department clinician and were to be admitted to hospital. Infants were randomised to either a standard pulse oximeter or a modified pulse oximeter (Rad-8, Masimo, CA). Modified oximeters would display SpO2 94 when actual SpO2 was 90% (smoothed readings above and below). Infants were followed up by standardised telephone calls at 7, 14, 28 days and 6 months.
Results 615 infants were randomised. 352 males, 263 female, Mean age 4.9 months (iqr 2.7–7.3). The effect of oxygen supplementation on recovery was measured by time to resolution of cough (primary outcome), time back to normal (parent perception), recovery of heart rate and respiratory rate, and need for oxygen supplementation during admission, number of healthcare re-attendances post discharge. The study database is now locked and a full analysis will be presented.
Conclusion In infants admitted to hospital with acute bronchiolitis, the effect of a target oxygen saturation of 90% on symptom recovery and healthcare re-attendance will be discussed. The results may help inform discussion on use of oxygen for symptom resolution and future healthcare planning, including the current use of home delivery of supplemental oxygen in acute viral bronchiolitis.
Funded by UK NIHR HTA (http://www.nets.nihr.ac.uk/projects/hta/099116). Oximetry kindly supportedby Masimo Corporation Ltd.