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Infants with artificially elevated pulse oximetry levels less likely to be hospitalised during an episode of mild to moderate bronchiolitis

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Design: Double-blind single-centre randomised trial.

Allocation: Concealed (web-based randomisation).

Blinding: Emergency department physicians, nurses, families and research nurses were all blinded to group assignment.

Study question

Setting: Tertiary-care paediatric emergency department in Toronto.

Patients: Previously healthy infants aged 4 weeks to 12 months diagnosed with mild to moderate bronchiolitis. Children with cardiopulmonary, neuromuscular, haematological or congenital airway anomalies, triage saturations <88%, severe respiratory distress or those transferred from other centres were excluded.

Intervention: Random allocation to either true oxygen saturation or altered saturation (saturation measurements three points higher to a maximum of 100%).

Outcomes: Hospitalisation within 72 h; use of supplemental oxygen in the emergency department; level of physician agreement with discharge from emergency department; length of emergency department stay; unscheduled visits for bronchiolitis within 72 h.

Follow-up period: 72 h.

Patient follow-up: 213 children randomised; 108 were assigned to receive true oximetry measurements and 105 to receive altered oximetry measurements. No patients discontinued the intervention or were lost to follow-up and all were therefore included in the final analysis.

Main results

Patients in the true oxygen saturation group were significantly more likely to be hospitalised than those in the altered oxygen saturation group. There were no significant differences between the two groups with regard to any of the other outcomes (see table 1).

View this table:
Table 1

Outcome of altering oximetry on discharge


Among infants presenting to an emergency department with mild-to-moderate bronchiolitis, those with artificially increased oxygen saturations were less likely …

Correspondence to Dr Ian D Wacogne, Department of General Paediatrics, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; ian.wacogne{at}

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  • Twitter Follow Rebecca Dicks at @becksDrD

  • Contributors DK drafted the abstract to the ‘discharge’ paper. RMD drafted the abstract to the ‘permissive hypoxia’ paper. IDW drafted the commentary, and all commented and edited the other's work.

  • Provenance and peer review Commissioned; internally peer reviewed.