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Wednesday, March 22, 2006

Home Oxygen After Observation May Be Acceptable for Children With Bronchiolitis

Discharge from the emergency department (ED) on home oxygen after a period
of observation is acceptable for children with bronchiolitis, according to
the results of a prospective, randomized trial reported in the March issue
of Pediatrics.
"Hypoxia is a common reason for hospital admission in infants and children
with acute bronchiolitis," write Lalit Bajaj, MD, MPH, from the University
of Colorado Health Sciences Center and Children's Hospital in Denver, and
colleagues. "No study has evaluated discharge from the ED on home oxygen.
This study evaluated the feasibility and safety of ED discharge on home
oxygen in the treatment of acute bronchiolitis."
From December 1998 to April 2001, 92 infants and children with acute
bronchiolitis and hypoxia presenting to an urban, academic, tertiary care
children's hospital ED were randomized to receive inpatient admission (n =
39; 42%) or home oxygen (n = 53; 58%) after an 8-hour observation period in
the ED. Age range was 2 to 24 months, and room-air saturations were 87% or
less. Outcomes included failure to meet discharge criteria during the
observation period, return for hospital admission, and incidence of serious
Both groups were similar in age, initial room-air saturation, and
respiratory distress severity score. Of 53 patients randomized to the home
oxygen group, 37 (70%) completed the observation period and were discharged
from the hospital. Of the remaining 16 patients in this group, 6 were
excluded from the study, 5 resolved their oxygen requirement, and 5 failed
to meet the discharge criteria and were admitted. One discharged patient
returned to the hospital and was admitted for a cyanotic spell at home after
the 24-hour follow-up appointment; his hospital course was uncomplicated,
with a length of stay of 45 hours. The remaining 36 patients (97%) were
successfully treated with home oxygen as outpatients. Both caregivers and
their primary care providers (PCPs) expressed high satisfaction with home
"Discharge from the ED on home oxygen after a period of observation is an
option for patients with acute bronchiolitis," the authors write. "Secondary
to the low incidence of complications, the safety of this practice will
require a larger study."
Study limitations include sample size too small to evaluate the ideal period
of observation, lack of data on patients who were not enrolled, potential
selection bias, use of a referred population limiting generalizability of
the findings, lack of blinding, strict inclusion and exclusion criteria,
performance of the study at an altitude of 5280 feet, and study termination
before enrollment of the desired number of patients.
"We found that an 8-hour observation period identifies those patients who
may resolve their oxygen requirement and those who may worsen and require
hospital admission, and, because of a low incidence of complications, the
8-hour observation period is an option for management," the authors
conclude. "High acceptance rates by caregivers and PCPs supports this
approach. Additional study is necessary to determine safety and economic


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