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      Successful Use of Quality Improvement Methodology to Reduce Inpatient Length of Stay in Bronchiolitis Through Judicious Use of Intermittent Pulse Oximetry

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          Most cited references 13

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          Trends in bronchiolitis hospitalizations in the United States, 2000-2009.

          To examine temporal trend in the national incidence of bronchiolitis hospitalizations, use of mechanical ventilation, and hospital charges between 2000 and 2009.
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            Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis.

            The goal was to establish the final supportive therapy determinants of hospital length of stay for bronchiolitis. A retrospective case study of a randomly selected 25% of subjects <1 year of age who were hospitalized with bronchiolitis between April 1, 2003, and June 15, 2005 (n = 129), was performed. Records of 102 admissions to the general wards were reviewed (77 respiratory syncytial virus positive). Length of stay, pulse oxygen saturation profile, oxygen supplementation, feeding support, and nasal suction were determined. Infants admitted to the PICU (27 admissions) were excluded. The majority of patients presented with feeding difficulties (82% at admission). Oxygen supplementation was not indicated initially for the majority of infants (22% with mean pulse oxygen saturation of 94%). However, oxygen treatment was required by 70% of infants by 6 hours, whereas the mean pulse oxygen saturation decreased by an average of only 2%. Feeding problems were resolved for 98% of infants by 96 hours, followed by oxygen supplementation resolving with an average lag of 66 hours. The mean pulse oxygen saturation at discharge was 95%. There was no significant correlation between pulse oxygen saturation at arrival at the emergency department and subsequent oxygen requirements or length of stay. Oxygen supplementation is the prime determinant of the length of hospitalization for infants with bronchiolitis. Infants remaining in the hospital for oxygen supplementation once feeding difficulties had resolved did not experience deterioration to the extent of needing PICU support.
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              Clinical risk factors are more relevant than respiratory viruses in predicting bronchiolitis severity †

              Abstract Background The role of respiratory viruses in the pathogenesis of bronchiolitis was re‐evaluated with the use of molecular methods such as PCR for virus detection. Whether specific viruses or the classical clinical risk factors are more important in determining severe bronchiolitis is not well established. Aim To analyze the specific viruses and clinical variables that can predict severe bronchiolitis at admission. Methods Nasopharyngeal aspirates were prospectively collected from 484 children <12 months admitted to the pediatrics ward or PICU at Universitary Hospital Sant Joan de Déu (Barcelona, Spain) for bronchiolitis from October 2007 to October 2008. Clinical and demographic data were collected. Sixteen respiratory viruses were studied using PCR. Severity was assessed with a bronchiolitis clinical score (BCS). Results Four hundred ten infants that tested positive for respiratory viruses were analyzed. Mixed viral infections did not increase the severity of the disease. Rhinovirus was associated with severe BCS in univariate analysis (P = 0.041), but in the multivariate logistic regression including viruses and clinical data only bronchopulmonary dysplasia (OR 7.2; 95% CI 1.2–43.3), congenital heart disease (OR 4.7; 95% CI 1.1–19.9), prematurity (OR 2.6; 95% CI 1.3–5.1), and fever (OR 1.8, 95% CI 1.1–3.1) showed statistical significance for predicting severe BCS. Conclusions Classical clinical risk factors have more weight in predicting a severe BCS in infants with acute bronchiolitis than the involved viruses. Pediatr Pulmonol. 2013; 48:456–463. © 2012 Wiley Periodicals, Inc.
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                Author and article information

                Journal
                Hospital Pediatrics
                Hospital Pediatrics
                American Academy of Pediatrics (AAP)
                2154-1663
                2154-1671
                February 01 2019
                February 2019
                February 2019
                January 03 2019
                : 9
                : 2
                : 73-78
                Article
                10.1542/hpeds.2018-0023
                © 2019

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