Oxygen saturations targets in infants with bronchiolitis: Is 90% as effective as 94%?

Abstract

There is no clear consensus about target oxygen saturations for children with bronchiolitis. Cunningham and colleagues1 completed a double-blind randomised trial evaluating the equivalence of target oxygen saturations of 90% (intervention) versus 94% (standard) in bronchiolitis. The authors recruited 615 infants 6 weeks to 12 months of age and used a primary outcome of resolution of cough as a measure of resolution of illness. It found equivalence between the two groups, with time to resolution of cough of 15 days (median difference 0 days (confidence interval – 1 to 2). Equivalence was defined as +/−2 days. We question the use of cough as an outcome. Cough has not been shown to contribute to readmission rates in children with acute bronchiolitis discharged on home oxygen2 and has not been identified as a barrier to discharge in patients with bronchiolitis including those with an oxygen requirement.3 The secondary outcomes in this study (time to normal feeding and time to fit for discharge) are more clinically relevant. The study showed trends towards earlier discharge (40.9 h vs. 50.9 h, P 0.003) and earlier return to normal feeding (19.5 h vs. 24.1 h, median difference 2.7 (−0.3 to 7.3)), in the intervention group. These, combined with no increased adverse events, are stronger support of using lower target saturations than equivalence of cough resolution.