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preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng9er1-lrg.png" alt="Cover of Evidence reviews for criteria for referral, admission, oxygen supplementation, and discharge" /></a></div><div class="bkr_bib"><h1 id="_NBK573296_"><span itemprop="name">Evidence reviews for criteria for referral, admission, oxygen supplementation, and discharge</span></h1><div class="subtitle">Bronchiolitis in children: diagnosis and management</div><p><b>Evidence review A</b></p><p><i>NICE Guideline, No. 9</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2021 Aug</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-1162-2</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div></div><div class="bkr_clear"></div></div><div id="niceng9er1.s1"><h2 id="_niceng9er1_s1_">1. Criteria for referral, admission, oxygen supplementation, and discharge</h2><div id="niceng9er1.s1.1"><h3>1.1. Review question</h3><p>What thresholds of oxygen saturation should indicate that a baby or child with suspected or confirmed bronchiolitis should be immediately referred to hospital, admitted to hospital, given supplementary oxygen, and can be safely discharged?</p><div id="niceng9er1.s1.1.1"><h4>1.1.1. Introduction</h4><p>Bronchiolitis is a lower respiratory tract infection most reported in babies under the age of one. Symptoms are similar to those of the common cold but can be associated with serious outcomes. Therefore, identifying babies and children who are experiencing, or are likely to experience, more severe disease is important for choosing appropriate care. Current NICE guidance recommends that oxygen saturation below 92% should be considered alongside other criteria when deciding if babies and children with suspected bronchiolitis should be referred to hospital, admitted, given supplementary oxygen, or discharged.</p><p>A Health Technology Assessment concluded that a lower oxygen saturation threshold could be no less safe than the current threshold of 92%. A review of this evidence is timely, as the incidence of new cases of bronchiolitis may not follow typical seasonal trends during the SARS-COV-2 pandemic (diagnosis of COVID in babies and children presenting with suspected bronchiolitis is outside of the scope of this update, but guidance on this has been produced by the <a href="https://www.rcpch.ac.uk/resources/national-guidance-management-children-bronchiolitis-during-covid-19" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Royal College of Paediatrics and Child Health</a>). It is important to avoid unnecessary admissions and excessive length of stay in hospital as these may not be of benefit to some babies and children with bronchiolitis and may also have wider impacts on provision of care. This review will assess if an oxygen saturation threshold lower than the current recommendation of 92% is safe with respect to referral to hospital, admission to hospital, indicating oxygen supplementation, and discharge.</p></div><div id="niceng9er1.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng9er1tab1"><a href="/books/NBK573296/table/niceng9er1.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng9er1tab1" rid-ob="figobniceng9er1tab1"><img class="small-thumb" src="/books/NBK573296/table/niceng9er1.tab1/?report=thumb" src-large="/books/NBK573296/table/niceng9er1.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng9er1.tab1"><a href="/books/NBK573296/table/niceng9er1.tab1/?report=objectonly" target="object" rid-ob="figobniceng9er1tab1">Table</a></h4><p class="float-caption no_bottom_margin">Inclusion: babies and children with suspected or confirmed bronchiolitis, including subgroups particularly at risk from severe disease for example: babies and children born prematurely and babies and children with:
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congenital heart disease cystic fibrosis <a href="/books/NBK573296/table/niceng9er1.tab1/?report=objectonly" target="object" rid-ob="figobniceng9er1tab1">(more...)</a></p></div></div></div><div id="niceng9er1.s1.1.3"><h4>1.1.3. Methods and process</h4><p>Risk of bias was assessed in randomised controlled trials (RCTs) with the Cochrane risk of bias tool (2.0), and in observational studies with the ROBINS-I tool. Results of the risk of bias assessments can be found alongside the evidence table for each study (<a href="#niceng9er1.appd.et1">Appendices D.1</a> and <a href="#niceng9er1.appd.et2">D.2</a>). Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to present results and to evaluate the quality of evidence by outcomes (see <a href="#niceng9er1.appe">Appendix E</a>). GRADE assessment domains include risk of bias, inconsistency, indirectness, and imprecision. Outcomes start at High, for example, for a randomised controlled trial, and can be marked down 1 or 2 levels for each domain through to Moderate, Low and Very Low evidence. Observational studies start at Low. Each of the evidence quality ratings are explained below:
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<ul class="simple-list"><li class="half_rhythm"><div>High – Further research is very unlikely to change our confidence in the estimate of effect.</div></li><li class="half_rhythm"><div>Moderate – Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.</div></li><li class="half_rhythm"><div>Low – Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.</div></li><li class="half_rhythm"><div>Very low – Any estimate of effect is very uncertain.</div></li></ul></p><p>No evidence pooling was done for this review, therefore the evidence for each outcome in GRADE is provided by 1 study only.</p><p>There were no published minimally important differences (MIDs) available, so imprecision was graded based on default thresholds of 0.7 and 1.25 for risk ratios and hazard ratios. If either confidence interval crosses a threshold, the evidence is downgraded by 1 level. If both thresholds are crossed, the evidence is downgraded 2 levels.</p><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/resources/appendix-l-interim-process-and-methods-for-guidelines-developed-in-response-to-health-and-social-care-emergencies-8779776589/chapter/1-introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual using Appendix L: Interim process and methods for guidelines developed in response to health and social care emergencies</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng9er1.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng9er1.s1.1.4"><h4>1.1.4. Effectiveness evidence</h4><div id="niceng9er1.s1.1.4.1"><h5>1.1.4.1. Evidence from the 2015 review</h5><p>The studies included in the review conducted for the 2015 version of this guideline did not meet the inclusion criteria set out in the protocol for the 2021 review. This is because the studies did not compare 2 or more pre-specified oxygen saturation thresholds at which babies and children should be referred, admitted, given supplemental oxygen, and discharged from hospital, as specified by the current review protocol.</p></div><div id="niceng9er1.s1.1.4.2"><h5>1.1.4.2. Included studies from the 2021 review</h5><p>528 studies were identified by the search, 481 were excluded based on a title and abstract sift, and 47 were included for full text review. 2 studies were included: 1 randomised controlled trial reported in 2 publications, and 1 prospective observational study.</p></div><div id="niceng9er1.s1.1.4.3"><h5>1.1.4.3. Excluded studies from the 2021 review</h5><p>44 studies were excluded after full text review (<a href="#niceng9er1.appi">Appendix I</a>).</p></div></div><div id="niceng9er1.s1.1.5"><h4>1.1.5. Summary of studies included in the effectiveness evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng9er1tab2"><a href="/books/NBK573296/table/niceng9er1.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng9er1tab2" rid-ob="figobniceng9er1tab2"><img class="small-thumb" src="/books/NBK573296/table/niceng9er1.tab2/?report=thumb" src-large="/books/NBK573296/table/niceng9er1.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng9er1.tab2"><a href="/books/NBK573296/table/niceng9er1.tab2/?report=objectonly" target="object" rid-ob="figobniceng9er1tab2">Table</a></h4><p class="float-caption no_bottom_margin">
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Cunningham 2015
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RCT</p></div></div><p>See <a href="#niceng9er1.appd">appendix D</a> for full evidence tables.</p></div><div id="niceng9er1.s1.1.6"><h4>1.1.6. Summary of the effectiveness evidence</h4><p>There were 2 studies relevant to the review protocol: a Health Technology Assessment (HTA) randomised controlled trial that compared management to a target of 90% oxygen saturation to the level of 94% oxygen saturation recommended at the time by the Scottish Intercollegiate Guidelines Network (<a href="https://www.sign.ac.uk/our-guidelines/bronchiolitis-in-children/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">SIGN 91, 2006</a>); and a prospective observational study that compared 90% to 92% oxygen saturation as a threshold for admission.</p><p>The HTA reported 10 outcomes relevant to the review protocol.</p><p>The primary outcome of the HTA (time to cough resolution) was not included in the review protocol. However the HTA was an equivalence trial designed around cough resolution, therefore in a deviation from the protocol, evidence on cough was included in the current review and presented to the committee to allow them to decide on its relevance to the discussion around changes to oxygen saturation thresholds.</p><p>In GRADE, evidence quality ranged from high to low quality across the outcomes. The only domain where outcomes were marked down was imprecision, since the outcomes were considered to have a low risk of bias as the study is directly applicable to the review question, and could not be downgraded for inconsistency because it was not included in a meta-analysis. The committee believed that although the HTA used a comparator saturation threshold of 94% (rather than 92% which was the threshold recommended in the 2015 version of the guideline), it should not be marked down for indirectness.</p><p>For the results below, lower values indicate a better outcome for the 90% intervention arm unless otherwise stated.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng9er1tab3"><a href="/books/NBK573296/table/niceng9er1.tab3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng9er1tab3" rid-ob="figobniceng9er1tab3"><img class="small-thumb" src="/books/NBK573296/table/niceng9er1.tab3/?report=thumb" src-large="/books/NBK573296/table/niceng9er1.tab3/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng9er1.tab3"><a href="/books/NBK573296/table/niceng9er1.tab3/?report=objectonly" target="object" rid-ob="figobniceng9er1tab3">Table</a></h4><p class="float-caption no_bottom_margin">90% arm: 276 94% arm: 283</p></div></div><p>The prospective observational study reported 1 outcome relevant to the protocol – length of stay. The study was rated as having a serious risk of bias, which translates as a very serious risk of bias in GRADE. As observational data starts in GRADE as “Low”, the outcome was rated as Very Low quality.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng9er1tab4"><a href="/books/NBK573296/table/niceng9er1.tab4/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng9er1tab4" rid-ob="figobniceng9er1tab4"><img class="small-thumb" src="/books/NBK573296/table/niceng9er1.tab4/?report=thumb" src-large="/books/NBK573296/table/niceng9er1.tab4/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng9er1.tab4"><a href="/books/NBK573296/table/niceng9er1.tab4/?report=objectonly" target="object" rid-ob="figobniceng9er1tab4">Table</a></h4><p class="float-caption no_bottom_margin">90% arm: 181 94% arm: 139</p></div></div><p>See <a href="#niceng9er1.appe">appendix E</a> for full GRADE tables.</p></div><div id="niceng9er1.s1.1.7"><h4>1.1.7. Economic evidence</h4><p>A full literature search for economic studies was not conducted. However, a search was conducted to look for economic evaluations linked to any of the studies included in the clinical evidence review.</p><div id="niceng9er1.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>One relevant study was identified for this review question, the <a class="bibr" href="#niceng9er1.s1.1.ref1" rid="niceng9er1.s1.1.ref1">Cunningham 2015</a> HTA report, which included an economic evaluation. A summary of the results is given below, with the full details reported in <a href="#niceng9er1.appf">Appendix F</a>.</p></div><div id="niceng9er1.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>No studies which were identified as potentially relevant to this evidence review were excluded.</p></div><div id="niceng9er1.s1.1.7.3"><h5>1.1.7.3. Summary of included economic evidence</h5><p>One directly applicable trial-based economic evaluation with minor limitations conducted in the UK found that an oxygen saturation target of ≥90% dominated (was both more effective and less expensive) an oxygen saturation target of ≥94% in babies between 6 weeks and 12 months with a clinical diagnosis of bronchiolitis who were admitted to hospital.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng9er1tab5"><a href="/books/NBK573296/table/niceng9er1.tab5/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng9er1tab5" rid-ob="figobniceng9er1tab5"><img class="small-thumb" src="/books/NBK573296/table/niceng9er1.tab5/?report=thumb" src-large="/books/NBK573296/table/niceng9er1.tab5/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng9er1.tab5"><a href="/books/NBK573296/table/niceng9er1.tab5/?report=objectonly" target="object" rid-ob="figobniceng9er1tab5">Table</a></h4><p class="float-caption no_bottom_margin">
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<i>Population:</i>
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Babies between 6 weeks and 12 months with a clinical diagnosis of bronchiolitis who were admitted to hospital.</p></div></div></div><div id="niceng9er1.s1.1.7.4"><h5>1.1.7.4. Economic model</h5><p>No economic modelling was undertaken for this review question, as it was decided the published economic evidence was sufficient for decision making.</p></div></div><div id="niceng9er1.s1.1.8"><h4>1.1.8. The committee’s discussion and interpretation of the evidence</h4><div id="niceng9er1.s1.1.8.1"><h5>1.1.8.1. The outcomes that matter most</h5><p>The committee noted that once bronchiolitis is resolved there are usually no long-term consequences, and the key objective in bronchiolitis management is to ensure that babies and children have full resolution without complications.</p><p>The critical outcomes are change in respiratory rate, change in oxygen saturation, reported feeding difficulty, readmission rate, length of stay, and the need for high flow humidified oxygen, CPAP or mechanical ventilation. Length of stay and readmission rate were noted as contributing to improved flow of patients through the system.</p><p>The committee noted that the significantly reduced number of readmissions to hospital within 28 days in the 90% saturation threshold arm of the HTA appeared to be clinically implausible. The study investigators suggested that this may be linked to a shorter hospital stay and consequently a lower risk of oxygen toxicity (though the committee felt this was unlikely to be an issue in readmissions up to 28 days) or less exposure to nosocomial infections.</p><p>The HTA reported an outcome of return to feeding at 75% of normal. However, data for this outcome were not included in the guideline update because the definition of this outcome was not well reported, and hence its relevance to the ‘reported feeding difficulty’ outcome of the review protocol was uncertain.</p><p>Important outcomes are dehydration, work of breathing, adverse events (including mortality), change in oxygen saturation, change in arterial or capillary blood carbon dioxide levels, change in disease severity score, change in respiratory rate, and need for feeding support (either tube feeding or intravenous fluids). Mortality was considered an important rather than a critical outcome because bronchiolitis has a relatively low mortality rate. However, the committee noted that the 2 deaths reported in the HTA were events that they did not expect to have occurred in a low-risk population (i.e. babies and children aged 6 weeks to 1 year without certain comorbidities) and that ordinarily no baby or child should die from this condition.</p><p>Although the primary outcome of the HTA was cough resolution, the committee stated that this was an unusual choice and was not a key clinical concern, therefore cough resolution was not considered a critical or important outcome. However, they acknowledged that cough resolution was an important factor for parents and carers, which could trigger reattendance if it is causing concern, and lay members recalled from experience that cough can linger for several weeks and prevent babies from sleeping. Lay members noted that overall, cough was not the key concern for them, and breathing difficulties were the more worrying issue.</p><p>The committee also noted that some babies in hospital improve on very little oxygen to reach the target saturation threshold, but when asleep saturation can suddenly dip which may cause a delay to discharge in a baby or child who is otherwise recovering.</p></div><div id="niceng9er1.s1.1.8.2"><h5>1.1.8.2. The quality of the evidence</h5><p>Two studies were included in the update.</p><p>A Health Technology Assessment (HTA) study involving an RCT was assessed as low risk of bias. Overall, the RCT was well conducted and reported, with minor issues relating to the reporting of the definition of cough resolution and return to normal feeding. The overall outcome quality in the HTA ranged from high to low. The only domain in which outcomes were marked down was imprecision, since the outcomes were considered to have a low risk of bias as the study is directly applicable to the review question, and could not be downgraded for inconsistency because it was not included in a meta-analysis.</p><p>A prospective observational study was assessed as serious risk of bias. A key issue was that it compared 2 different groups of centres and baseline characteristics were not reported or adjusted for, therefore population and use of co-interventions were unlikely to be balanced across the 2 groups. It reported only 1 outcome relevant to the protocol which was rated as very low quality due to serious risk of bias of the study.</p><p>The committee felt the population of the HTA (babies aged 6 weeks to 12 months with bronchiolitis, newly admitted to hospital in the UK) was directly applicable to the review question, and that an upper age limit of 12 months was appropriate to exclude other wheezing phenotypes more common in older babies which could complicate the evidence. The committee did however note that that the study excluded babies with certain comorbidities that made them a higher risk for a more serious case of bronchiolitis and so the included population was at lower risk than is typically seen in hospital.</p><p>The intervention of the HTA did not align exactly with the existing NICE recommendation on oxygen saturation thresholds of 92%, instead comparing 90% with 94% saturation thresholds. The committee agreed that this was still of relevance to the review question, but noted that if a threshold of 92% had been used in the HTA then differences between the intervention arms may have been slightly attenuated.</p><p>The committee discussed in detail the relevance of the HTA to the 4 distinct domains of the review question: referral, admission, management and discharge. They agreed that the HTA was directly relevant to management and discharge, of some relevance to admission (because the babies in the study were being assessed in an emergency department and therefore undergoing a period of observation), but of no relevance to referral. The committee were therefore able to transpose the findings of the HTA directly to recommendations on management and discharge, and cautiously to recommendations on admission. The HTA was not considered in the committee’s discussion of recommendations on referral.</p><p>The committee judged the observational study to be of very low quality because of its observational study design and very serious risk of bias for evaluating an intervention. Although it was of relevance to the admission domain of the review question, the committee did not consider it during their discussion of recommendations on admission.</p></div><div id="niceng9er1.s1.1.8.3"><h5>1.1.8.3. Benefits and harms</h5><div id="niceng9er1.s1.1.8.3.1"><h5>Referral</h5><p>The committee noted that there was no evidence identified by the review that covered referral. However, as the committee had agreed based on the evidence to amend the recommendations for oxygen saturation for admission, management and discharge to a 90% threshold, some babies and children could theoretically get stuck within the care pathway. A scenario could arise where a child discharged with an oxygen saturation of 91% was re-referred immediately back to hospital if the discharge threshold were lowered to 90% oxygen saturation, while the referral threshold remained at 92%. To overcome this, they decided to move the oxygen saturation referral criterion so that it no could no longer trigger an immediate referral to emergency care in the absence of other indications, but would instead be a criterion which healthcare professionals could use to consider a non-immediate referral.</p><p>The committee considered whether the change in other recommendations would mean babies and children would be re-referred immediately after being discharged. They considered whether this was a possibility in clinical practice, rather than only a problem with pathway logic. The committee noted that it was unlikely for a child to be brought back to primary care by parents unless they also had other symptoms. By the time children are discharged from hospital, the child’s status is improving, and their oxygen saturation is unlikely to decrease. When a child needs referring based on other symptoms, oxygen saturation is made redundant by the other presenting symptoms. However, the committee brought up that some children are visited by community nurses who do take oxygen saturation measurements. By leaving the recommendation as immediate referral based on 92% oxygen saturation, this could mean the child is unnecessarily re-referred by healthcare professionals following the guidance.</p><p>To stop this loop, the committee assessed how oxygen saturation should be used in decision making. They indicated that the current recommendation places too much emphasis on the importance of oxygen saturation. Therefore, the committee decided to remove the oxygen saturation criterion from the immediate referral recommendation and place it with the criteria that healthcare professionals should use to consider non-immediate referral to hospital. This will allow healthcare professionals to exercise more clinical judgement for individual cases concerning oxygen saturation. The committee agreed that the other criteria for immediate referral were more serious and did require an immediate referral into hospital. They did not think that an oxygen saturation of below 92% alone was sufficient for immediate referral.</p><p>In addition, the committee noted that, in some cases, children may not be referred to hospital when they are displaying other symptoms listed needing immediate referral because their oxygen saturation is above the threshold for immediate referral, even if other referral criteria are present. Moving the oxygen saturation threshold to the list of criteria where a hospital referral can be considered puts less emphasis on oxygen saturation alone as the reason for referral. The committee also wanted the guideline to demonstrate that other criteria are more clinically useful than oxygen saturation.</p><p>The committee did not want to remove the oxygen saturation criterion completely or to change the oxygen saturation threshold. They said that oxygen saturation for young children might sometimes be less reliably measured in primary care, particularly if centres do not have the correct probes for children and babies. This could mean people are given a false sense of security if a reading is above the threshold for referral. The committee agreed that healthcare professionals in primary care were not able to make assessments on bronchiolitis based on oxygen saturation alone. They said that at this stage it is better to be cautious and allow specialists to make judgements since low oxygen saturation can also indicate other conditions. They also stated that oxygen saturations below 92% are likely to co-present with other symptoms.</p></div><div id="niceng9er1.s1.1.8.3.2"><h5>Admission</h5><p>The committee considered both studies in the review for this recommendation. Even though the prospective observational study was directly applicable to admission, the committee did not feel that the evidence was of a sufficiently high quality to influence their decision making. They considered that the RCT evidence, which assessed discharge criteria, could be applied to this part of the pathway because children are assessed in the same departments as they were treated in in the trial. Therefore, their considerations come from the RCT evidence, their own experiences, with an additional motivation to ensure a logical and consistent approach with the recommendations for management and discharge.</p><p>The committee agreed that the oxygen saturation threshold for admission could be lowered to 90% for children who were not otherwise considered to be at high risk of a serious case of bronchiolitis due to their age or any co-existing health conditions. The recommendations currently advise that a ‘persistent’ oxygen saturation of concern indicates admission. From their experience, when children are assessed they can remain in units for a few hours before an admission decision is made. Within this time oxygen saturation can be monitored persistently, but other symptoms would also be observed. If the child does not present any other symptoms listed in recommendation 1.3.2 during assessment, the committee were satisfied that a child with oxygen saturations over 90% could safely not be admitted. However, the committee agreed it would be safer to retain the threshold of 92% for children at higher risk (i.e. babies under 6 weeks or babies and children of any age with underlying health conditions), as these were not represented in the evidence discussed.</p><p>The committee noted that the stage at which the child is in the disease course will affect how healthcare professionals should interpret oxygen saturation. The condition of a child at day 1 or 2 with lower oxygen saturation should be treated with more caution than a child with the same oxygen saturation threshold at day 4 or 5. The committee noted the importance of identifying whether the child is in the worsening stage or the improving stage of the illness. This should influence how the healthcare professionals interpret oxygen saturation and other symptoms.</p><p>The committee were satisfied that recommendation 1.6.1 provided enough information to support parents and carers when children were not admitted. This was another safety measure that was seen as necessary as parents and carers are often moved between GP surgeries, walk-in centres and A&E. As recommendation 1.6.1 provides additional information that healthcare professionals should provide to parents and carers (recognising red flag symptoms; that people should not smoke in the child’s home because it increases the risk of more severe symptoms in bronchiolitis; how to get immediate help from an appropriate professional if any red flag symptoms develop; arrangements for follow-up if necessary) the committee said children who do not meet the admission criteria can be more safely released home.</p><p>On balance, the committee were assured that the oxygen saturation threshold could be safely lowered in the recommendations for admission. The committee stressed the importance of taking other symptoms into account and not using oxygen saturation in isolation to make decisions.</p></div><div id="niceng9er1.s1.1.8.3.3"><h5>Management</h5><p>The committee considered the RCT evidence to be directly applicable to this recommendation. They also took into account the resource burden of delivering oxygen supplementation and whether the child is in a worsening or improving phase of illness.</p><p>The evidence from the RCT showed that the need for supplemental oxygen at a threshold of 90% was significantly lower than with a 94% threshold. The previous committee made a recommendation for 92% based on consensus. As there is now RCT evidence that demonstrates a lower need for supplemental oxygen at lower thresholds the committee agreed to adjust the threshold in line with the evidence. In addition, this may give healthcare professionals flexibility to manage resources during periods of high demand such as localised outbreaks of respiratory conditions.</p><p>They were also reassured by knowing that oxygen is not considered alone during decision making. Assessments on heart function, feeding, and percussion, for example, are used alongside oxygen saturation to provide a fuller picture of the child’s status. Additionally, oxygen supplementation is not the only treatment for low oxygen saturation and these treatments may be indicated by other symptoms. As changing oxygen saturation affects only one part of the whole picture, the committee were satisfied that it was a safe decision.</p><p>The committee were concerned that the trial had excluded high-risk children (i.e. babies under 6 weeks or with underlying health conditions) and therefore retained the previous threshold of 92% oxygen saturation for children in this group. There are also other recommendations in the Management of bronchiolitis section of the guideline provide advice for managing children in this group.</p></div><div id="niceng9er1.s1.1.8.3.4"><h5>Discharge</h5><p>The committee considered the RCT in this review to be directly applicable to discharge. The outcomes were either equivalent across the two groups or indicated a benefit of a lower oxygen saturation discharge threshold. As the previously recommended 92% was based on committee consensus, the committee decided that the evidence presented for a threshold of 90% superseded committee consensus in children who were not considered to be at high risk based on age or co-existing conditions. For these children, the previous threshold of 92% was retained.</p><p>The RCT was an equivalence trial, designed to demonstrate that there should be no difference in outcomes between treatment arms. However, there were 2 outcomes relating to discharge where the lower oxygen threshold of 90% was statistically associated with a more favourable result. The first was time to actual discharge in hours, which was reduced for the modified oximeter group, and which the committee said was reflective of clinical practice. This is because children who had higher oxygen saturation levels than the oximeter was showing would have fewer symptoms than children whose oxygen saturations were lower. This was reassuring for the committee as it showed a benefit for reducing the threshold by improving patient flow and allowing children to go home earlier if they are well enough. Additionally, the observational study was aligned with the findings of the RCT in that length of stay was significantly lower with a 90% versus a 92% saturation threshold for admission.</p><p>The committee felt this demonstrates that other factors are taken into account when healthcare professionals are decision making. They were confident that the other criteria in the discharge recommendation (clinical stability and adequate intake of oral fluids), would be a good barrier to prevent unwell children from being discharged. In addition, the committee noted that this may allow children who are well or consistently improving, but only have a slightly lower oxygen saturation measure than the current threshold to return home and avoid an unnecessarily prolonged stay. The committee noted that there remained a need to make healthcare professionals aware of factors that may mean discharge is not suitable (for example, social circumstances, the skill and confidence of the parent or carer in looking after a child with bronchiolitis at home, confidence in the parent or carer being able to spot red flag symptoms, distance to healthcare in case of deterioration) and that this awareness would provide a safety net.</p><p>The second outcome relevant to discharge that was significantly different between the trial arms was readmission to hospital within 28 days, with fewer readmissions in the 90% versus the 94% saturation threshold group. However, the trial authors explained this unexpected result by children not picking up infections by being in the hospital for a shorter duration, and also considered the potential role of oxygen toxicity caused by treatment during the initial admission, which may lead to readmission at a later date. The committee commented on this finding by saying it was biologically implausible and therefore potentially a chance finding.</p></div></div><div id="niceng9er1.s1.1.8.4"><h5>1.1.8.4. Cost effectiveness and resource use</h5><p>The economic analysis conducted alongside the Cunningham HTA report found a reduction in both within-hospital and follow-up costs with a 90% oxygen saturation target compared to a 94% target. The committee were not convinced by the finding around follow-up costs as they were not clear of the mechanism by which the use of a lower saturation target would result in lower follow-up costs but did agree the reductions in within hospital costs matched their expectations, due to both reduced oxygen therapy and reduced length of stay with a lower target. The committee agreed the study showed the lower target was highly likely to be both cost-saving and cost-effective. The committee noted this study was directly applicable to the recommendations on management and discharge, and therefore reductions in costs would be expected from the implementation of those recommendations.</p><p>The economic analysis in the HTA was less directly applicable to the recommendations around referral and admission. The committee were unsure how many fewer people would be admitted based on a lowering of the oxygen saturation threshold for admission, as some people not meeting the lower target would still be admitted for other reasons (for example, based on their symptoms). However, they agreed this recommendation could not increase costs, as it would lead to either very similar or a reduced number of people being admitted but could not lead to an increase.</p></div><div id="niceng9er1.s1.1.8.5"><h5>1.1.8.5. Other factors the committee took into account</h5><p>In consideration of issues identified in the equality impact assessment, the committee acknowledged emerging reports in other areas of clinical care that there may be variation in the accuracy of pulse oximetry for some patients due to variations in skin tone. The committee stated that they were not presented with any evidence during this update which could lead to a specific recommendation on this topic. They agreed that this issue sits outside the scope of this update and is not unique to the diagnosis and management of bronchiolitis, and therefore no research recommendation was made. The NHS Race and Health Observatory published a rapid review of the evidence in this area in March 2021. NICE will monitor for formal guidance from NHS England and NHS Improvement in this area, and update this guideline further as needed.</p><p>The committee noted that socioeconomic status and geographical factors may influence the ability of people to travel to hospital by private transport. They said that getting to hospital urgently if a child’s health is deteriorating is an important factor to consider when discharging children. They were reassured that recommendation 1.6.1 covered this adequately by noting ‘distance to healthcare in case of deterioration’ is a factor to take into account when discharging.</p><p>The committee noted from their experience some issues with implementation of existing recommendations. Some children may not be referred to hospital when they present with symptoms that are recommended for immediate referral because their oxygen saturations are above 92%. The committee hoped that the changes to recommendations for admission, which reduce the importance of oxygen saturation, will improve care in this area.</p><p>The committee noted that there was no direct evidence to guide referral to hospital based on oxygen saturation thresholds. The need for a research recommendation in this area was discussed, but it was felt that there could be ethical concerns with denying children referral to hospital on the basis of an oxygen saturation reading.</p></div></div><div id="niceng9er1.s1.1.rl.r1"><h4>1.1.9. References – included studies</h4><ul class="simple-list"><div id="niceng9er1.s1.1.rl.r1.1"><h5>1.1.9.1. Effectiveness</h5><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng9er1.s1.1.ref1">Cunningham, Steve, Rodriguez, Aryelly, Adams, Tim
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et al. (2015) Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet (London, England)
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386(9998): 1041–8 [<a href="/pmc/articles/PMC4673090/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4673090</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26382998" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26382998</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng9er1.s1.1.ref2">Cunningham, Steve, Rodriguez, Aryelly, Boyd, Kathleen A
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et al. (2015) Bronchiolitis of Infancy Discharge Study (BIDS): a multicentre, parallel-group, double-blind, randomised controlled, equivalence trial with economic evaluation. Health technology assessment (Winchester, England)
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19(71): i–172 [<a href="/pmc/articles/PMC4780975/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4780975</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26364905" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26364905</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng9er1.s1.1.ref3">van Hasselt, Tim J, Singham, Bhavna, Bassett, Eve
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et al. (2020) Oxygen saturation thresholds in bronchiolitis: examining admissions. Archives of disease in childhood
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105(12): 1197–1199 [<a href="https://pubmed.ncbi.nlm.nih.gov/31462433" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31462433</span></a>]</div></p></li></ul></div><div id="niceng9er1.s1.1.rl.r1.2"><h5>1.1.9.2. Economic</h5><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng9er1.s1.1.ref4">Cunningham, Steve, Rodriguez, Aryelly, Boyd, Kathleen A
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et al. (2015) Bronchiolitis of Infancy Discharge Study (BIDS): a multicentre, parallel-group, double-blind, randomised controlled, equivalence trial with economic evaluation. Health technology assessment (Winchester, England)
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19(71): i–172 [<a href="/pmc/articles/PMC4780975/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4780975</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26364905" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26364905</span></a>]</div></p></li></ul></div><div id="niceng9er1.s1.1.rl.r1.3"><h5>1.1.9.3. Other</h5><ul class="simple-list"><p>None</p></ul></div></ul></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng9er1.appa"><h3>Appendix A. Review protocols</h3><p id="niceng9er1.appa.et1"><a href="/books/NBK573296/bin/niceng9er1-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for criteria for referral, admission, oxygen supplementation, and discharge</a><span class="small"> (PDF, 355K)</span></p></div><div id="niceng9er1.appb"><h3>Appendix B. Literature search strategies</h3><p>What thresholds of oxygen saturation should indicate that a child with suspected or confirmed bronchiolitis should be immediately referred to hospital, admitted to hospital, given supplementary oxygen, and can be safely discharged?</p><div id="niceng9er1.appb.s1"><h4>Medline: Systematic Reviews and RCTs</h4><p>1<sup>st</sup> August 2014 to 28<sup>th</sup> May 2021</p><ol><li class="half_rhythm"><div>exp Child/ (1970664)</div></li><li class="half_rhythm"><div>(child* or preschool* or pre-school* or toddler* or kid* or kindergar* or minor or minors or boy* or girl* or daycare or day-care or nurser*).ti,ab. (2025559)</div></li><li class="half_rhythm"><div>exp Infant/ (1169550)</div></li><li class="half_rhythm"><div>(infan* or prematur* or pre-matur* or preterm* or pre-term* or neonat* or neo-nat* or perinat* or peri-nat* or newborn* or baby or babies).ti,ab. (833856)</div></li><li class="half_rhythm"><div>exp Pediatrics/ (60084)</div></li><li class="half_rhythm"><div>p?ediatric*.ti,ab. (320152)</div></li><li class="half_rhythm"><div>or/1-6 (3755371)</div></li><li class="half_rhythm"><div>exp Bronchiolitis/ (8876)</div></li><li class="half_rhythm"><div>Bronchioles/ (527)</div></li><li class="half_rhythm"><div>bronchiol*.ti,ab. (17838)</div></li><li class="half_rhythm"><div>or/8-10 (20277)</div></li><li class="half_rhythm"><div>exp Oximetry/ (15651)</div></li><li class="half_rhythm"><div>Oxygen/ (167905)</div></li><li class="half_rhythm"><div>(oximet* or S?O2 or O?SAT?).ti,ab. (32480)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (saturat* or monitor*)).ti,ab. (31383)</div></li><li class="half_rhythm"><div>or/12-15 (211277)</div></li><li class="half_rhythm"><div>exp Oxygen Inhalation Therapy/ (26841)</div></li><li class="half_rhythm"><div>exp Positive-Pressure Respiration/ (26887)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (therap* or supplement* or humidif* or unhumidif* or high flow or insufflat* or inhal*)).ti,ab. (21073)</div></li><li class="half_rhythm"><div>high flow nasal cannul*.ti,ab. (932)</div></li><li class="half_rhythm"><div>(CPAP or nCPAP or nmCPAP or npCPAP or n-CPAP or nm-CPAP or np-CPAP or PEEP or IMV or PPV or HFNC).ti,ab. (29427)</div></li><li class="half_rhythm"><div>(positive adj3 pressure adj3 (ventilat* or respirat* or breath* or airway*)).ti,ab. (17600)</div></li><li class="half_rhythm"><div>(airway pressure release adj3 (ventilat* or respirat* or breath*)).ti,ab. (236)</div></li><li class="half_rhythm"><div>positive end expiratory pressur*.ti,ab. (5538)</div></li><li class="half_rhythm"><div>continuous distend* pressur*.ti,ab. (66)</div></li><li class="half_rhythm"><div>(intermittent adj3 (ventilat* or respirat* or breath*)).ti,ab. (3195)</div></li><li class="half_rhythm"><div>or/17-26 (88099)</div></li><li class="half_rhythm"><div>16 or 27 (283399)</div></li><li class="half_rhythm"><div>7 and 11 and 28 (975)</div></li><li class="half_rhythm"><div>limit 29 to ed=20140801-20210531 (375)</div></li><li class="half_rhythm"><div>limit 30 to (english language and yr=“2014 -Current”) (340)</div></li><li class="half_rhythm"><div>Animals/ not humans/ (4800821)</div></li><li class="half_rhythm"><div>31 not 32 (334)</div></li><li class="half_rhythm"><div>(addresses or autobiography or bibliography or biography or case reports or clinical conference or comment or congresses or consensus development conference or consensus development conference, nih or dictionary or directory or duplicate publication or editorial or historical article or in vitro or interactive tutorial or interview or lectures or legal cases or legislation or letter or news or newspaper article or overall or patient education handout or periodical index or portraits or video-audio media or webcasts).pt. (4259504)</div></li><li class="half_rhythm"><div>(case report* or case series).ti. (227187)</div></li><li class="half_rhythm"><div>34 or 35 (4287041)</div></li><li class="half_rhythm"><div>33 not 36 (280)</div></li><li class="half_rhythm"><div>(MEDLINE or pubmed).tw. (187488)</div></li><li class="half_rhythm"><div>systematic review.tw. (143079)</div></li><li class="half_rhythm"><div>systematic review.pt. (152897)</div></li><li class="half_rhythm"><div>meta-analysis.pt. (132958)</div></li><li class="half_rhythm"><div>intervention$.ti. (134949)</div></li><li class="half_rhythm"><div>or/38-42 (425632)</div></li><li class="half_rhythm"><div>37 and 43 (36)</div></li><li class="half_rhythm"><div>randomized controlled trial.pt. (531705)</div></li><li class="half_rhythm"><div>randomi?ed.mp. (843480)</div></li><li class="half_rhythm"><div>placebo.mp. (203157)</div></li><li class="half_rhythm"><div>or/45-47 (896593)</div></li><li class="half_rhythm"><div>37 and 48 (88)</div></li><li class="half_rhythm"><div>44 or 49 (97)</div></li></ol></div><div id="niceng9er1.appb.s2"><h4>Medline: Observational studies</h4><p>1<sup>st</sup> August 2014 to 9<sup>th</sup> June 2021</p><ol><li class="half_rhythm"><div>exp Child/ (1973913)</div></li><li class="half_rhythm"><div>(child* or preschool* or pre-school* or toddler* or kid* or kindergar* or minor or minors or boy* or girl* or daycare or day-care or nurser*).ti,ab. (2029768)</div></li><li class="half_rhythm"><div>exp Infant/ (1171150)</div></li><li class="half_rhythm"><div>(infan* or prematur* or pre-matur* or preterm* or pre-term* or neonat* or neo-nat* or perinat* or peri-nat* or newborn* or baby or babies).ti,ab. (835436)</div></li><li class="half_rhythm"><div>exp Pediatrics/ (60164)</div></li><li class="half_rhythm"><div>p?ediatric*.ti,ab. (321093)</div></li><li class="half_rhythm"><div>or/1-6 (3761758)</div></li><li class="half_rhythm"><div>exp Bronchiolitis/ (8891)</div></li><li class="half_rhythm"><div>Bronchioles/ (528)</div></li><li class="half_rhythm"><div>bronchiol*.ti,ab. (17863)</div></li><li class="half_rhythm"><div>or/8-10 (20305)</div></li><li class="half_rhythm"><div>exp Oximetry/ (15662)</div></li><li class="half_rhythm"><div>Oxygen/ (168043)</div></li><li class="half_rhythm"><div>(oximet* or S?O2 or O?SAT?).ti,ab. (32601)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (saturat* or monitor*)).ti,ab. (31450)</div></li><li class="half_rhythm"><div>or/12-15 (211560)</div></li><li class="half_rhythm"><div>exp Oxygen Inhalation Therapy/ (26887)</div></li><li class="half_rhythm"><div>exp Positive-Pressure Respiration/ (26916)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (therap* or supplement* or humidif* or unhumidif* or high flow or insufflat* or inhal*)).ti,ab. (21143)</div></li><li class="half_rhythm"><div>high flow nasal cannul*.ti,ab. (944)</div></li><li class="half_rhythm"><div>(CPAP or nCPAP or nmCPAP or npCPAP or n-CPAP or nm-CPAP or np-CPAP or PEEP or IMV or PPV or HFNC).ti,ab. (29544)</div></li><li class="half_rhythm"><div>(positive adj3 pressure adj3 (ventilat* or respirat* or breath* or airway*)).ti,ab. (17634)</div></li><li class="half_rhythm"><div>(airway pressure release adj3 (ventilat* or respirat* or breath*)).ti,ab. (238)</div></li><li class="half_rhythm"><div>positive end expiratory pressur*.ti,ab. (5549)</div></li><li class="half_rhythm"><div>continuous distend* pressur*.ti,ab. (66)</div></li><li class="half_rhythm"><div>(intermittent adj3 (ventilat* or respirat* or breath*)).ti,ab. (3196)</div></li><li class="half_rhythm"><div>or/17-26 (88316)</div></li><li class="half_rhythm"><div>16 or 27 (283879)</div></li><li class="half_rhythm"><div>7 and 11 and 28 (976)</div></li><li class="half_rhythm"><div>limit 29 to ed=20140801-20210630 (376)</div></li><li class="half_rhythm"><div>limit 30 to (english language and yr=“2014 -Current”) (341)</div></li><li class="half_rhythm"><div>Animals/ not humans/ (4806148)</div></li><li class="half_rhythm"><div>31 not 32 (335)</div></li><li class="half_rhythm"><div>(addresses or autobiography or bibliography or biography or case reports or clinical conference or comment or congresses or consensus development conference or consensus development conference, nih or dictionary or directory or duplicate publication or editorial or historical article or in vitro or interactive tutorial or interview or lectures or legal cases or legislation or letter or news or newspaper article or overall or patient education handout or periodical index or portraits or video-audio media or webcasts).pt. (4265333)</div></li><li class="half_rhythm"><div>33 not 34 (281)</div></li><li class="half_rhythm"><div>Observational Studies as Topic/ (6396)</div></li><li class="half_rhythm"><div>Observational Study/ (100472)</div></li><li class="half_rhythm"><div>Epidemiologic Studies/ (8691)</div></li><li class="half_rhythm"><div>exp Case-Control Studies/ (1181454)</div></li><li class="half_rhythm"><div>exp Cohort Studies/ (2148266)</div></li><li class="half_rhythm"><div>Cross-Sectional Studies/ (369939)</div></li><li class="half_rhythm"><div>Controlled Before-After Studies/ (618)</div></li><li class="half_rhythm"><div>Historically Controlled Study/ (204)</div></li><li class="half_rhythm"><div>Interrupted Time Series Analysis/ (1252)</div></li><li class="half_rhythm"><div>Comparative Study.pt. (1891461)</div></li><li class="half_rhythm"><div>case control$.tw. (119257)</div></li><li class="half_rhythm"><div>case series.tw. (65288)</div></li><li class="half_rhythm"><div>(cohort adj (study or studies)).tw. (195295)</div></li><li class="half_rhythm"><div>cohort analy$.tw. (7601)</div></li><li class="half_rhythm"><div>(follow up adj (study or studies)).tw. (46837)</div></li><li class="half_rhythm"><div>(observational adj (study or studies)).tw. (97897)</div></li><li class="half_rhythm"><div>longitudinal.tw. (221973)</div></li><li class="half_rhythm"><div>prospective.tw. (529706)</div></li><li class="half_rhythm"><div>retrospective.tw. (488624)</div></li><li class="half_rhythm"><div>cross sectional.tw. (318421)</div></li><li class="half_rhythm"><div>or/36-55 (4589118)</div></li><li class="half_rhythm"><div>35 and 56 (166)</div></li></ol></div><div id="niceng9er1.appb.s3"><h4>Medline in-Process: Systematic Reviews and RCTs</h4><p>1<sup>st</sup> August 2014 to 28<sup>th</sup> May 2021</p><ol><li class="half_rhythm"><div>exp Child/ (0)</div></li><li class="half_rhythm"><div>(child* or preschool* or pre-school* or toddler* or kid* or kindergar* or minor or minors or boy* or girl* or daycare or day-care or nurser*).ti,ab,kw. (50824)</div></li><li class="half_rhythm"><div>exp Infant/ (0)</div></li><li class="half_rhythm"><div>(infan* or prematur* or pre-matur* or preterm* or pre-term* or neonat* or neo-nat* or perinat* or peri-nat* or newborn* or baby or babies).ti,ab,kw. (19453)</div></li><li class="half_rhythm"><div>exp Pediatrics/ (0)</div></li><li class="half_rhythm"><div>p?ediatric*.ti,ab,kw. (14069)</div></li><li class="half_rhythm"><div>or/1-6 (68911)</div></li><li class="half_rhythm"><div>exp Bronchiolitis/ (0)</div></li><li class="half_rhythm"><div>Bronchioles/ (0)</div></li><li class="half_rhythm"><div>bronchiol*.ti,ab,kw. (330)</div></li><li class="half_rhythm"><div>or/8-10 (330)</div></li><li class="half_rhythm"><div>exp Oximetry/ (0)</div></li><li class="half_rhythm"><div>Oxygen/ (0)</div></li><li class="half_rhythm"><div>(oximet* or S?O2 or O?SAT?).ti,ab,kw. (1006)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (saturat* or monitor*)).ti,ab,kw. (859)</div></li><li class="half_rhythm"><div>or/12-15 (1553)</div></li><li class="half_rhythm"><div>exp Oxygen Inhalation Therapy/ (0)</div></li><li class="half_rhythm"><div>exp Positive-Pressure Respiration/ (0)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (therap* or supplement* or humidif* or unhumidif* or high flow or insufflat* or inhal*)).ti,ab,kw. (599)</div></li><li class="half_rhythm"><div>high flow nasal cannul*.ti,ab,kw. (104)</div></li><li class="half_rhythm"><div>(CPAP or nCPAP or nmCPAP or npCPAP or n-CPAP or nm-CPAP or np-CPAP or PEEP or IMV or PPV or HFNC).ti,ab,kw. (1307)</div></li><li class="half_rhythm"><div>(positive adj3 pressure adj3 (ventilat* or respirat* or breath* or airway*)).ti,ab,kw. (491)</div></li><li class="half_rhythm"><div>(airway pressure release adj3 (ventilat* or respirat* or breath*)).ti,ab,kw. (3)</div></li><li class="half_rhythm"><div>positive end expiratory pressur*.ti,ab,kw. (108)</div></li><li class="half_rhythm"><div>continuous distend* pressur*.ti,ab,kw. (1)</div></li><li class="half_rhythm"><div>(intermittent adj3 (ventilat* or respirat* or breath*)).ti,ab,kw. (28)</div></li><li class="half_rhythm"><div>or/17-26 (2138)</div></li><li class="half_rhythm"><div>16 or 27 (3537)</div></li><li class="half_rhythm"><div>7 and 11 and 28 (37)</div></li><li class="half_rhythm"><div>limit 29 to dt=20140801-20210531 (37)</div></li><li class="half_rhythm"><div>limit 30 to yr=2014-current (37)</div></li><li class="half_rhythm"><div>Meta-Analysis.pt. (61)</div></li><li class="half_rhythm"><div>Review.pt. (40441)</div></li><li class="half_rhythm"><div>(metaanaly$ or metanaly$ or (meta adj2 analy$)).tw. (11265)</div></li><li class="half_rhythm"><div>(review$ or overview$).ti. (22781)</div></li><li class="half_rhythm"><div>(systematic$ adj4 (review$ or overview$)).tw. (14201)</div></li><li class="half_rhythm"><div>((quantitative$ or qualitative$) adj4 (review$ or overview$)).tw. (603)</div></li><li class="half_rhythm"><div>((studies or trial$) adj1 (review$ or overview$)).tw. (670)</div></li><li class="half_rhythm"><div>(integrat$ adj2 (research or review$ or literature)).tw. (672)</div></li><li class="half_rhythm"><div>(pool$ adj1 (analy$ or data)).tw. (1089)</div></li><li class="half_rhythm"><div>(handsearch$ or (hand adj2 search$)).tw. (237)</div></li><li class="half_rhythm"><div>(manual$ adj2 search$).tw. (187)</div></li><li class="half_rhythm"><div>or/32-42 (60280)</div></li><li class="half_rhythm"><div>31 and 43 (2)</div></li><li class="half_rhythm"><div>((random$ or control$ or clinical$) adj2 (trial$ or stud$)).tw. (36904)</div></li><li class="half_rhythm"><div>(random$ adj2 allocat$).tw. (990)</div></li><li class="half_rhythm"><div>placebo$.tw. (4790)</div></li><li class="half_rhythm"><div>((singl$ or doubl$ or trebl$ or tripl$) adj (blind$ or mask$)).tw. (3607)</div></li><li class="half_rhythm"><div>(crossover$ or (cross adj over$)).tw. (1976)</div></li><li class="half_rhythm"><div>or/45-49 (40053)</div></li><li class="half_rhythm"><div>31 and 50 (5)</div></li><li class="half_rhythm"><div>44 or 51 (5)</div></li></ol></div><div id="niceng9er1.appb.s4"><h4>Medline in-Process: Observational studies</h4><p>1<sup>st</sup> August 2014 to 9<sup>th</sup> June 2021</p><ol><li class="half_rhythm"><div>exp Child/ (0)</div></li><li class="half_rhythm"><div>(child* or preschool* or pre-school* or toddler* or kid* or kindergar* or minor or minors or boy* or girl* or daycare or day-care or nurser*).ti,ab,kw. (50322)</div></li><li class="half_rhythm"><div>exp Infant/ (0)</div></li><li class="half_rhythm"><div>(infan* or prematur* or pre-matur* or preterm* or pre-term* or neonat* or neo-nat* or perinat* or peri-nat* or newborn* or baby or babies).ti,ab,kw. (19195)</div></li><li class="half_rhythm"><div>exp Pediatrics/ (0)</div></li><li class="half_rhythm"><div>p?ediatric*.ti,ab,kw. (13985)</div></li><li class="half_rhythm"><div>or/1-6 (68182)</div></li><li class="half_rhythm"><div>exp Bronchiolitis/ (0)</div></li><li class="half_rhythm"><div>Bronchioles/ (0)</div></li><li class="half_rhythm"><div>bronchiol*.ti,ab,kw. (338)</div></li><li class="half_rhythm"><div>or/8-10 (338)</div></li><li class="half_rhythm"><div>exp Oximetry/ (0)</div></li><li class="half_rhythm"><div>Oxygen/ (0)</div></li><li class="half_rhythm"><div>(oximet* or S?O2 or O?SAT?).ti,ab,kw. (939)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (saturat* or monitor*)).ti,ab,kw. (855)</div></li><li class="half_rhythm"><div>or/12-15 (1483)</div></li><li class="half_rhythm"><div>exp Oxygen Inhalation Therapy/ (0)</div></li><li class="half_rhythm"><div>exp Positive-Pressure Respiration/ (0)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (therap* or supplement* or humidif* or unhumidif* or high flow or insufflat* or inhal*)).ti,ab,kw. (595)</div></li><li class="half_rhythm"><div>high flow nasal cannul*.ti,ab,kw. (104)</div></li><li class="half_rhythm"><div>(CPAP or nCPAP or nmCPAP or npCPAP or n-CPAP or nm-CPAP or np-CPAP or PEEP or IMV or PPV or HFNC).ti,ab,kw. (1288)</div></li><li class="half_rhythm"><div>(positive adj3 pressure adj3 (ventilat* or respirat* or breath* or airway*)).ti,ab,kw. (494)</div></li><li class="half_rhythm"><div>(airway pressure release adj3 (ventilat* or respirat* or breath*)).ti,ab,kw. (1)</div></li><li class="half_rhythm"><div>positive end expiratory pressur*.ti,ab,kw. (108)</div></li><li class="half_rhythm"><div>continuous distend* pressur*.ti,ab,kw. (1)</div></li><li class="half_rhythm"><div>(intermittent adj3 (ventilat* or respirat* or breath*)).ti,ab,kw. (30)</div></li><li class="half_rhythm"><div>or/17-26 (2121)</div></li><li class="half_rhythm"><div>16 or 27 (3443)</div></li><li class="half_rhythm"><div>7 and 11 and 28 (40)</div></li><li class="half_rhythm"><div>limit 29 to dt=20140801-20210630 (40)</div></li><li class="half_rhythm"><div>limit 30 to yr=2014-current (40)</div></li></ol></div><div id="niceng9er1.appb.s5"><h4>Medline epub: Systematic Reviews and RCTs</h4><p>1<sup>st</sup> August 2014 to 28<sup>th</sup> May 2021</p><ol><li class="half_rhythm"><div>exp Child/ (0)</div></li><li class="half_rhythm"><div>(child* or preschool* or pre-school* or toddler* or kid* or kindergar* or minor or minors or boy* or girl* or daycare or day-care or nurser*).ti,ab,kw. (36895)</div></li><li class="half_rhythm"><div>exp Infant/ (0)</div></li><li class="half_rhythm"><div>(infan* or prematur* or pre-matur* or preterm* or pre-term* or neonat* or neo-nat* or perinat* or peri-nat* or newborn* or baby or babies).ti,ab,kw. (14463)</div></li><li class="half_rhythm"><div>exp Pediatrics/ (0)</div></li><li class="half_rhythm"><div>p?ediatric*.ti,ab,kw. (9994)</div></li><li class="half_rhythm"><div>or/1-6 (50198)</div></li><li class="half_rhythm"><div>exp Bronchiolitis/ (0)</div></li><li class="half_rhythm"><div>Bronchioles/ (0)</div></li><li class="half_rhythm"><div>bronchiol*.ti,ab,kw. (297)</div></li><li class="half_rhythm"><div>or/8-10 (297)</div></li><li class="half_rhythm"><div>exp Oximetry/ (0)</div></li><li class="half_rhythm"><div>Oxygen/ (0)</div></li><li class="half_rhythm"><div>(oximet* or S?O2 or O?SAT?).ti,ab,kw. (933)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (saturat* or monitor*)).ti,ab,kw. (615)</div></li><li class="half_rhythm"><div>or/12-15 (1345)</div></li><li class="half_rhythm"><div>exp Oxygen Inhalation Therapy/ (0)</div></li><li class="half_rhythm"><div>exp Positive-Pressure Respiration/ (0)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (therap* or supplement* or humidif* or unhumidif* or high flow or insufflat* or inhal*)).ti,ab,kw. (548)</div></li><li class="half_rhythm"><div>high flow nasal cannul*.ti,ab,kw. (93)</div></li><li class="half_rhythm"><div>(CPAP or nCPAP or nmCPAP or npCPAP or n-CPAP or nm-CPAP or np-CPAP or PEEP or IMV or PPV or HFNC).ti,ab,kw. (993)</div></li><li class="half_rhythm"><div>(positive adj3 pressure adj3 (ventilat* or respirat* or breath* or airway*)).ti,ab,kw. (421)</div></li><li class="half_rhythm"><div>(airway pressure release adj3 (ventilat* or respirat* or breath*)).ti,ab,kw. (7)</div></li><li class="half_rhythm"><div>positive end expiratory pressur*.ti,ab,kw. (77)</div></li><li class="half_rhythm"><div>continuous distend* pressur*.ti,ab,kw. (0)</div></li><li class="half_rhythm"><div>(intermittent adj3 (ventilat* or respirat* or breath*)).ti,ab,kw. (39)</div></li><li class="half_rhythm"><div>or/17-26 (1748)</div></li><li class="half_rhythm"><div>16 or 27 (2955)</div></li><li class="half_rhythm"><div>7 and 11 and 28 (27)</div></li><li class="half_rhythm"><div>limit 29 to dt=20140801-20210531 (26)</div></li><li class="half_rhythm"><div>limit 30 to yr=2014-current (26)</div></li><li class="half_rhythm"><div>Meta-Analysis.pt. (92)</div></li><li class="half_rhythm"><div>Review.pt. (45355)</div></li><li class="half_rhythm"><div>(metaanaly$ or metanaly$ or (meta adj2 analy$)).tw. (8005)</div></li><li class="half_rhythm"><div>(review$ or overview$).ti. (16703)</div></li><li class="half_rhythm"><div>(systematic$ adj4 (review$ or overview$)).tw. (11174)</div></li><li class="half_rhythm"><div>((quantitative$ or qualitative$) adj4 (review$ or overview$)).tw. (510)</div></li><li class="half_rhythm"><div>((studies or trial$) adj1 (review$ or overview$)).tw. (497)</div></li><li class="half_rhythm"><div>(integrat$ adj2 (research or review$ or literature)).tw. (396)</div></li><li class="half_rhythm"><div>(pool$ adj1 (analy$ or data)).tw. (709)</div></li><li class="half_rhythm"><div>(handsearch$ or (hand adj2 search$)).tw. (221)</div></li><li class="half_rhythm"><div>(manual$ adj2 search$).tw. (156)</div></li><li class="half_rhythm"><div>or/32-42 (60177)</div></li><li class="half_rhythm"><div>31 and 43 (4)</div></li><li class="half_rhythm"><div>((random$ or control$ or clinical$) adj2 (trial$ or stud$)).tw. (24585)</div></li><li class="half_rhythm"><div>(random$ adj2 allocat$).tw. (653)</div></li><li class="half_rhythm"><div>placebo$.tw. (3195)</div></li><li class="half_rhythm"><div>((singl$ or doubl$ or trebl$ or tripl$) adj (blind$ or mask$)).tw. (2333)</div></li><li class="half_rhythm"><div>(crossover$ or (cross adj over$)).tw. (1379)</div></li><li class="half_rhythm"><div>or/45-49 (26981)</div></li><li class="half_rhythm"><div>31 and 50 (4)</div></li><li class="half_rhythm"><div>44 or 51 (7)</div></li></ol></div><div id="niceng9er1.appb.s6"><h4>Medline epub: Observational Studies</h4><p>1<sup>st</sup> August 2014 to 9<sup>th</sup> June 2021</p><ol><li class="half_rhythm"><div>exp Child/ (0)</div></li><li class="half_rhythm"><div>(child* or preschool* or pre-school* or toddler* or kid* or kindergar* or minor or minors or boy* or girl* or daycare or day-care or nurser*).ti,ab,kw. (36977)</div></li><li class="half_rhythm"><div>exp Infant/ (0)</div></li><li class="half_rhythm"><div>(infan* or prematur* or pre-matur* or preterm* or pre-term* or neonat* or neo-nat* or perinat* or peri-nat* or newborn* or baby or babies).ti,ab,kw. (14449)</div></li><li class="half_rhythm"><div>exp Pediatrics/ (0)</div></li><li class="half_rhythm"><div>p?ediatric*.ti,ab,kw. (10050)</div></li><li class="half_rhythm"><div>or/1-6 (50287)</div></li><li class="half_rhythm"><div>exp Bronchiolitis/ (0)</div></li><li class="half_rhythm"><div>Bronchioles/ (0)</div></li><li class="half_rhythm"><div>bronchiol*.ti,ab,kw. (281)</div></li><li class="half_rhythm"><div>or/8-10 (281)</div></li><li class="half_rhythm"><div>exp Oximetry/ (0)</div></li><li class="half_rhythm"><div>Oxygen/ (0)</div></li><li class="half_rhythm"><div>(oximet* or S?O2 or O?SAT?).ti,ab,kw. (879)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (saturat* or monitor*)).ti,ab,kw. (614)</div></li><li class="half_rhythm"><div>or/12-15 (1296)</div></li><li class="half_rhythm"><div>exp Oxygen Inhalation Therapy/ (0)</div></li><li class="half_rhythm"><div>exp Positive-Pressure Respiration/ (0)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (therap* or supplement* or humidif* or unhumidif* or high flow or insufflat* or inhal*)).ti,ab,kw. (541)</div></li><li class="half_rhythm"><div>high flow nasal cannul*.ti,ab,kw. (101)</div></li><li class="half_rhythm"><div>(CPAP or nCPAP or nmCPAP or npCPAP or n-CPAP or nm-CPAP or np-CPAP or PEEP or IMV or PPV or HFNC).ti,ab,kw. (1010)</div></li><li class="half_rhythm"><div>(positive adj3 pressure adj3 (ventilat* or respirat* or breath* or airway*)).ti,ab,kw. (408)</div></li><li class="half_rhythm"><div>(airway pressure release adj3 (ventilat* or respirat* or breath*)).ti,ab,kw. (7)</div></li><li class="half_rhythm"><div>positive end expiratory pressur*.ti,ab,kw. (79)</div></li><li class="half_rhythm"><div>continuous distend* pressur*.ti,ab,kw. (0)</div></li><li class="half_rhythm"><div>(intermittent adj3 (ventilat* or respirat* or breath*)).ti,ab,kw. (38)</div></li><li class="half_rhythm"><div>or/17-26 (1740)</div></li><li class="half_rhythm"><div>16 or 27 (2901)</div></li><li class="half_rhythm"><div>7 and 11 and 28 (25)</div></li><li class="half_rhythm"><div>limit 29 to dt=20140801-20210630 (24)</div></li><li class="half_rhythm"><div>limit 30 to yr=2014-current (24)</div></li></ol></div><div id="niceng9er1.appb.s7"><h4>Embase: Systematic Reviews and RCTs</h4><p>1<sup>st</sup> August 2014 to 28<sup>th</sup> May 2021</p><ol><li class="half_rhythm"><div>exp child/ (2737778)</div></li><li class="half_rhythm"><div>(child* or preschool* or pre-school* or toddler* or kid* or kindergar* or minor or minors or boy* or girl* or daycare or day-care or nurser*).ti,ab. (2917885)</div></li><li class="half_rhythm"><div>exp infant/ (1023254)</div></li><li class="half_rhythm"><div>(infan* or prematur* or pre-matur* or preterm* or pre-term* or neonat* or neo-nat* or perinat* or peri-nat* or newborn* or baby or babies).ti,ab. (1125735)</div></li><li class="half_rhythm"><div>exp pediatrics/ (112406)</div></li><li class="half_rhythm"><div>p?ediatric*.ti,ab. (587666)</div></li><li class="half_rhythm"><div>or/1-6 (4696109)</div></li><li class="half_rhythm"><div>exp bronchiolitis/ (23130)</div></li><li class="half_rhythm"><div>exp bronchiole/ (3635)</div></li><li class="half_rhythm"><div>bronchiol*.ti,ab. (27588)</div></li><li class="half_rhythm"><div>or/8-10 (36536)</div></li><li class="half_rhythm"><div>exp oximetry/ (28902)</div></li><li class="half_rhythm"><div>oxygen saturation/ (57220)</div></li><li class="half_rhythm"><div>oxygen/ (209416)</div></li><li class="half_rhythm"><div>(oximet* or S?O2 or O?SAT?).ti,ab. (70699)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (saturat* or monitor*)).ti,ab. (54359)</div></li><li class="half_rhythm"><div>or/12-16 (333855)</div></li><li class="half_rhythm"><div>exp oxygen therapy/ (66597)</div></li><li class="half_rhythm"><div>oxygen breathing/ (3368)</div></li><li class="half_rhythm"><div>exp intermittent mandatory ventilation/ (1411)</div></li><li class="half_rhythm"><div>exp intermittent positive pressure ventilation/ (3408)</div></li><li class="half_rhythm"><div>exp positive pressure ventilation/ (8347)</div></li><li class="half_rhythm"><div>pressure support ventilation/ (1736)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (therap* or supplement* or humidif* or unhumidif* or high flow or insufflat* or inhal*)).ti,ab. (34953)</div></li><li class="half_rhythm"><div>high flow nasal cannul*.ti,ab. (2384)</div></li><li class="half_rhythm"><div>(CPAP or nCPAP or nmCPAP or npCPAP or n-CPAP or nm-CPAP or np-CPAP or PEEP or IMV or PPV or HFNC).ti,ab. (65977)</div></li><li class="half_rhythm"><div>(positive adj3 pressure adj3 (ventilat* or respirat* or breath* or airway*)).ti,ab. (28862)</div></li><li class="half_rhythm"><div>(airway pressure release adj3 (ventilat* or respirat* or breath*)).ti,ab. (498)</div></li><li class="half_rhythm"><div>positive end expiratory pressur*.ti,ab. (7865)</div></li><li class="half_rhythm"><div>continuous distend* pressur*.ti,ab. (86)</div></li><li class="half_rhythm"><div>(intermittent adj3 (ventilat* or respirat* or breath*)).ti,ab. (4089)</div></li><li class="half_rhythm"><div>or/18-31 (174309)</div></li><li class="half_rhythm"><div>17 or 32 (473034)</div></li><li class="half_rhythm"><div>7 and 11 and 33 (2538)</div></li><li class="half_rhythm"><div>(201408* or 201409* or 20141* or 2015* or 2016* or 2017* or 2018* or 2019* or 2020* or 2021*).dc. (11680750)</div></li><li class="half_rhythm"><div>34 and 35 (1437)</div></li><li class="half_rhythm"><div>limit 36 to (english language and yr=“2014 -Current”) (1348)</div></li><li class="half_rhythm"><div>nonhuman/ not human/ (4805559)</div></li><li class="half_rhythm"><div>37 not 38 (1333)</div></li><li class="half_rhythm"><div>conference.pt. (4869711)</div></li><li class="half_rhythm"><div>book.pt. (1105)</div></li><li class="half_rhythm"><div>book series.pt. (0)</div></li><li class="half_rhythm"><div>editorial.pt. (692027)</div></li><li class="half_rhythm"><div>letter.pt. (1174850)</div></li><li class="half_rhythm"><div>note.pt. (851054)</div></li><li class="half_rhythm"><div>short survey.pt. (360319)</div></li><li class="half_rhythm"><div>case report/ (2615970)</div></li><li class="half_rhythm"><div>(case report* or case series).ti. (370023)</div></li><li class="half_rhythm"><div>40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 (10038790)</div></li><li class="half_rhythm"><div>39 not 49 (607)</div></li><li class="half_rhythm"><div>(MEDLINE or pubmed).tw. (299537)</div></li><li class="half_rhythm"><div>exp systematic review/ or systematic review.tw. (356045)</div></li><li class="half_rhythm"><div>meta-analysis/ (216221)</div></li><li class="half_rhythm"><div>intervention$.ti. (218201)</div></li><li class="half_rhythm"><div>or/51-54 (741085)</div></li><li class="half_rhythm"><div>50 and 55 (52)</div></li><li class="half_rhythm"><div>random:.tw. (1667264)</div></li><li class="half_rhythm"><div>placebo:.mp. (474734)</div></li><li class="half_rhythm"><div>double-blind:.tw. (220184)</div></li><li class="half_rhythm"><div>or/57-59 (1928376)</div></li><li class="half_rhythm"><div>50 and 60 (148)</div></li><li class="half_rhythm"><div>56 or 61 (167)</div></li></ol></div><div id="niceng9er1.appb.s8"><h4>Embase: Observational Studies</h4><p>1<sup>st</sup> August 2014 to 9<sup>th</sup> June 2021</p><ol><li class="half_rhythm"><div>exp child/ (2742167)</div></li><li class="half_rhythm"><div>(child* or preschool* or pre-school* or toddler* or kid* or kindergar* or minor or minors or boy* or girl* or daycare or day-care or nurser*).ti,ab. (2922515)</div></li><li class="half_rhythm"><div>exp infant/ (1024769)</div></li><li class="half_rhythm"><div>(infan* or prematur* or pre-matur* or preterm* or pre-term* or neonat* or neo-nat* or perinat* or peri-nat* or newborn* or baby or babies).ti,ab. (1127147)</div></li><li class="half_rhythm"><div>exp pediatrics/ (112525)</div></li><li class="half_rhythm"><div>p?ediatric*.ti,ab. (589451)</div></li><li class="half_rhythm"><div>or/1-6 (4702810)</div></li><li class="half_rhythm"><div>exp bronchiolitis/ (23159)</div></li><li class="half_rhythm"><div>exp bronchiole/ (3631)</div></li><li class="half_rhythm"><div>bronchiol*.ti,ab. (27602)</div></li><li class="half_rhythm"><div>or/8-10 (36562)</div></li><li class="half_rhythm"><div>exp oximetry/ (28977)</div></li><li class="half_rhythm"><div>oxygen saturation/ (57536)</div></li><li class="half_rhythm"><div>oxygen/ (209617)</div></li><li class="half_rhythm"><div>(oximet* or S?O2 or O?SAT?).ti,ab. (70925)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (saturat* or monitor*)).ti,ab. (54469)</div></li><li class="half_rhythm"><div>or/12-16 (334623)</div></li><li class="half_rhythm"><div>exp oxygen therapy/ (66988)</div></li><li class="half_rhythm"><div>oxygen breathing/ (3375)</div></li><li class="half_rhythm"><div>exp intermittent mandatory ventilation/ (1412)</div></li><li class="half_rhythm"><div>exp intermittent positive pressure ventilation/ (3409)</div></li><li class="half_rhythm"><div>exp positive pressure ventilation/ (8516)</div></li><li class="half_rhythm"><div>pressure support ventilation/ (1739)</div></li><li class="half_rhythm"><div>((oxygen* or O2) adj3 (therap* or supplement* or humidif* or unhumidif* or high flow or insufflat* or inhal*)).ti,ab. (35038)</div></li><li class="half_rhythm"><div>high flow nasal cannul*.ti,ab. (2395)</div></li><li class="half_rhythm"><div>(CPAP or nCPAP or nmCPAP or npCPAP or n-CPAP or nm-CPAP or np-CPAP or PEEP or IMV or PPV or HFNC).ti,ab. (66120)</div></li><li class="half_rhythm"><div>(positive adj3 pressure adj3 (ventilat* or respirat* or breath* or airway*)).ti,ab. (28898)</div></li><li class="half_rhythm"><div>(airway pressure release adj3 (ventilat* or respirat* or breath*)).ti,ab. (498)</div></li><li class="half_rhythm"><div>positive end expiratory pressur*.ti,ab. (7866)</div></li><li class="half_rhythm"><div>continuous distend* pressur*.ti,ab. (86)</div></li><li class="half_rhythm"><div>(intermittent adj3 (ventilat* or respirat* or breath*)).ti,ab. (4082)</div></li><li class="half_rhythm"><div>or/18-31 (174942)</div></li><li class="half_rhythm"><div>17 or 32 (474308)</div></li><li class="half_rhythm"><div>7 and 11 and 33 (2549)</div></li><li class="half_rhythm"><div>(201408* or 201409* or 20141* or 2015* or 2016* or 2017* or 2018* or 2019* or 2020* or 2021*).dc. (11731207)</div></li><li class="half_rhythm"><div>34 and 35 (1449)</div></li><li class="half_rhythm"><div>limit 36 to (english language and yr=“2014 -Current”) (1360)</div></li><li class="half_rhythm"><div>nonhuman/ not human/ (4808195)</div></li><li class="half_rhythm"><div>37 not 38 (1345)</div></li><li class="half_rhythm"><div>conference.pt. (4875254)</div></li><li class="half_rhythm"><div>book.pt. (1105)</div></li><li class="half_rhythm"><div>book series.pt. (0)</div></li><li class="half_rhythm"><div>editorial.pt. (692952)</div></li><li class="half_rhythm"><div>letter.pt. (1176240)</div></li><li class="half_rhythm"><div>note.pt. (852364)</div></li><li class="half_rhythm"><div>short survey.pt. (360300)</div></li><li class="half_rhythm"><div>40 or 41 or 42 or 43 or 44 or 45 or 46 (7958215)</div></li><li class="half_rhythm"><div>39 not 47 (731)</div></li><li class="half_rhythm"><div>Clinical study/ (155557)</div></li><li class="half_rhythm"><div>Case control study/ (173129)</div></li><li class="half_rhythm"><div>Family study/ (25308)</div></li><li class="half_rhythm"><div>Longitudinal study/ (156349)</div></li><li class="half_rhythm"><div>Retrospective study/ (1084669)</div></li><li class="half_rhythm"><div>comparative study/ (902010)</div></li><li class="half_rhythm"><div>Prospective study/ (688970)</div></li><li class="half_rhythm"><div>Randomized controlled trials/ (204458)</div></li><li class="half_rhythm"><div>55 not 56 (681182)</div></li><li class="half_rhythm"><div>Cohort analysis/ (713997)</div></li><li class="half_rhythm"><div>cohort analy$.tw. (14665)</div></li><li class="half_rhythm"><div>(Cohort adj (study or studies)).tw. (345010)</div></li><li class="half_rhythm"><div>(Case control$ adj (study or studies)).tw. (147393)</div></li><li class="half_rhythm"><div>(follow up adj (study or studies)).tw. (66211)</div></li><li class="half_rhythm"><div>(observational adj (study or studies)).tw. (191672)</div></li><li class="half_rhythm"><div>(epidemiologic$ adj (study or studies)).tw. (111282)</div></li><li class="half_rhythm"><div>(cross sectional adj (study or studies)).tw. (252954)</div></li><li class="half_rhythm"><div>case series.tw. (116607)</div></li><li class="half_rhythm"><div>prospective.tw. (928059)</div></li><li class="half_rhythm"><div>retrospective.tw. (986746)</div></li><li class="half_rhythm"><div>or/49-54,57-68 (4421208)</div></li><li class="half_rhythm"><div>48 and 69 (342)</div></li></ol></div><div id="niceng9er1.appb.s9"><h4>Cochrane Database of Systematic Reviews (CDSR) & CENTRAL</h4><p>Issue 5 of 12, May 2021</p><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>#1.</dt><dd><p class="no_top_margin">MeSH descriptor: [Child] explode all trees 57029</p></dd></dl><dl class="bkr_refwrap"><dt>#2.</dt><dd><p class="no_top_margin">(child* or preschool* or pre-school* or toddler* or kid* or kindergar* or minor or minors or boy* or girl* or daycare or day-care or nurser*):ti,ab 182632</p></dd></dl><dl class="bkr_refwrap"><dt>#3.</dt><dd><p class="no_top_margin">MeSH descriptor: [Infant] explode all trees 32600</p></dd></dl><dl class="bkr_refwrap"><dt>#4.</dt><dd><p class="no_top_margin">(infan* or prematur* or pre-matur* or preterm* or pre-term* or neonat* or neo-nat* or perinat* or peri-nat* or newborn* or baby or babies):ti,ab 73136</p></dd></dl><dl class="bkr_refwrap"><dt>#5.</dt><dd><p class="no_top_margin">MeSH descriptor: [Pediatrics] explode all trees 692</p></dd></dl><dl class="bkr_refwrap"><dt>#6.</dt><dd><p class="no_top_margin">p?ediatric*:ti,ab 33148</p></dd></dl><dl class="bkr_refwrap"><dt>#7.</dt><dd><p class="no_top_margin">{OR #1-#6} 260152</p></dd></dl><dl class="bkr_refwrap"><dt>#8.</dt><dd><p class="no_top_margin">MeSH descriptor: [Bronchiolitis] explode all trees 545</p></dd></dl><dl class="bkr_refwrap"><dt>#9.</dt><dd><p class="no_top_margin">MeSH descriptor: [Bronchioles] this term only 2</p></dd></dl><dl class="bkr_refwrap"><dt>#10.</dt><dd><p class="no_top_margin">bronchiol*:ti,ab 1446</p></dd></dl><dl class="bkr_refwrap"><dt>#11.</dt><dd><p class="no_top_margin">{OR #8-#10} 1499</p></dd></dl><dl class="bkr_refwrap"><dt>#12.</dt><dd><p class="no_top_margin">MeSH descriptor: [Oximetry] explode all trees 1036</p></dd></dl><dl class="bkr_refwrap"><dt>#13.</dt><dd><p class="no_top_margin">MeSH descriptor: [Oxygen] explode all trees 5523</p></dd></dl><dl class="bkr_refwrap"><dt>#14.</dt><dd><p class="no_top_margin">(oximet* or S?O2 or O?SAT?):ti,ab 9129</p></dd></dl><dl class="bkr_refwrap"><dt>#15.</dt><dd><p class="no_top_margin">((oxygen* or O2) NEAR/3 (saturat* or monitor*)):ti,ab 11314</p></dd></dl><dl class="bkr_refwrap"><dt>#16.</dt><dd><p class="no_top_margin">{OR #12-#15} 20394</p></dd></dl><dl class="bkr_refwrap"><dt>#17.</dt><dd><p class="no_top_margin">MeSH descriptor: [Oxygen Inhalation Therapy] explode all trees 1595</p></dd></dl><dl class="bkr_refwrap"><dt>#18.</dt><dd><p class="no_top_margin">MeSH descriptor: [Positive-Pressure Respiration] explode all trees 2795</p></dd></dl><dl class="bkr_refwrap"><dt>#19.</dt><dd><p class="no_top_margin">((oxygen* or O2) NEAR/3 (therap* or supplement* or humidif* or unhumidif* or “high flow” or insufflat* or inhal*)):ti,ab 6511</p></dd></dl><dl class="bkr_refwrap"><dt>#20.</dt><dd><p class="no_top_margin">(high NEXT flow NEXT nasal NEXT cannul*):ti,ab 784</p></dd></dl><dl class="bkr_refwrap"><dt>#21.</dt><dd><p class="no_top_margin">(CPAP or nCPAP or nmCPAP or npCPAP or n-CPAP or nm-CPAP or np-CPAP or PEEP or IMV or PPV or HFNC):ti,ab 8643</p></dd></dl><dl class="bkr_refwrap"><dt>#22.</dt><dd><p class="no_top_margin">(positive NEAR/3 pressure NEAR/3 (ventilat* or respirat* or breath* or airway*)):ti,ab 6176</p></dd></dl><dl class="bkr_refwrap"><dt>#23.</dt><dd><p class="no_top_margin">(airway NEXT pressure NEXT release NEAR/3 (ventilat* or respirat* or breath*)):ti,ab 79</p></dd></dl><dl class="bkr_refwrap"><dt>#24.</dt><dd><p class="no_top_margin">(positive NEXT end NEXT expiratory NEXT pressur*):ti,ab 1384</p></dd></dl><dl class="bkr_refwrap"><dt>#25.</dt><dd><p class="no_top_margin">(continuous NEXT distend* NEXT pressur*):ti,ab 22</p></dd></dl><dl class="bkr_refwrap"><dt>#26.</dt><dd><p class="no_top_margin">(intermittent NEAR/3 (ventilat* or respirat* or breath*)):ti,ab 860</p></dd></dl><dl class="bkr_refwrap"><dt>#27.</dt><dd><p class="no_top_margin">{OR #17-#26} 18155</p></dd></dl><dl class="bkr_refwrap"><dt>#28.</dt><dd><p class="no_top_margin">#16 or #27 34442</p></dd></dl><dl class="bkr_refwrap"><dt>#29.</dt><dd><p class="no_top_margin">#7 and #11 and #28 437</p></dd></dl><dl class="bkr_refwrap"><dt>#30.</dt><dd><p class="no_top_margin">#29 with Cochrane Library publication date Between Aug 2014 and May 2021, in Cochrane Reviews, Cochrane Protocols 7 (CDSR)</p></dd></dl><dl class="bkr_refwrap"><dt>#31.</dt><dd><p class="no_top_margin">#29 with Publication Year from 2014 to 2021, in Trials 231</p></dd></dl><dl class="bkr_refwrap"><dt>#32.</dt><dd><p class="no_top_margin">“conference”:pt or (clinicaltrials or trialsearch):so 543843</p></dd></dl><dl class="bkr_refwrap"><dt>#33.</dt><dd><p class="no_top_margin">#31 not #32 97 (CENTRAL)</p></dd></dl></dl></div></div><div id="niceng9er1.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng9er1.appc.et1"><a href="/books/NBK573296/bin/niceng9er1-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">C.1. PRISMA flow diagram of study selection</a><span class="small"> (PDF, 209K)</span></p></div><div id="niceng9er1.appd"><h3>Appendix D. Effectiveness and observational evidence</h3><p id="niceng9er1.appd.et1"><a href="/books/NBK573296/bin/niceng9er1-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">D.1. Effectiveness evidence</a><span class="small"> (PDF, 421K)</span></p><p id="niceng9er1.appd.et2"><a href="/books/NBK573296/bin/niceng9er1-appd-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">D.2. Observational evidence</a><span class="small"> (PDF, 276K)</span></p></div><div id="niceng9er1.appe"><h3>Appendix E. GRADE tables</h3><p id="niceng9er1.appe.et1"><a href="/books/NBK573296/bin/niceng9er1-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.1. GRADE profiles from randomised controlled trial evidence</a><span class="small"> (PDF, 194K)</span></p><p id="niceng9er1.appe.et2"><a href="/books/NBK573296/bin/niceng9er1-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.2. GRADE profiles from observational evidence</a><span class="small"> (PDF, 154K)</span></p></div><div id="niceng9er1.appf"><h3>Appendix F. Economic evidence tables</h3><p id="niceng9er1.appf.et1"><a href="/books/NBK573296/bin/niceng9er1-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (163K)</span></p></div><div id="niceng9er1.appg"><h3>Appendix G. Health economic model</h3><p>No economic modelling was undertaken for this review question, as it was decided the published economic evidence was sufficient for decision making.</p></div><div id="niceng9er1.apph"><h3>Appendix H. Excluded studies</h3><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng9er1apphtab1"><a href="/books/NBK573296/table/niceng9er1.apph.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figniceng9er1apphtab1" rid-ob="figobniceng9er1apphtab1"><img class="small-thumb" src="/books/NBK573296/table/niceng9er1.apph.tab1/?report=thumb" src-large="/books/NBK573296/table/niceng9er1.apph.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="niceng9er1.apph.tab1"><a href="/books/NBK573296/table/niceng9er1.apph.tab1/?report=objectonly" target="object" rid-ob="figobniceng9er1apphtab1">Table</a></h4><p class="float-caption no_bottom_margin">- Study does not contain a relevant intervention Oxygen saturation measured as a dichotomous variable, above and below 75%.</p></div></div></div><div id="niceng9er1.appi"><h3>Appendix I. Research recommendations</h3><p>The committee did not opt to make any research recommendations related to this evidence review.</p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.2.1, 1.2.2, 1.3.2, 1.4.4 and 1.5.1</p><p>These evidence reviews were developed by the Guideline Updates Team</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div><div class="small"><span class="label">Bookshelf ID: NBK573296</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/34464038" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">34464038</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng9er1tab1"><div id="niceng9er1.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573296/table/niceng9er1.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng9er1.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng9er1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Field</th><th id="hd_h_niceng9er1.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Content</th></tr></thead><tbody><tr><td headers="hd_h_niceng9er1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</td><td headers="hd_h_niceng9er1.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Inclusion: babies and children with suspected or confirmed bronchiolitis, including subgroups particularly at risk from severe disease for example:</p>
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<p>babies and children born prematurely and babies and children with:
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<ul><li class="half_rhythm"><div>congenital heart disease</div></li><li class="half_rhythm"><div>cystic fibrosis</div></li><li class="half_rhythm"><div>immunodeficiency</div></li><li class="half_rhythm"><div>chronic lung disease.</div></li></ul>
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Exclusions:
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<ul><li class="half_rhythm"><div>Adults</div></li><li class="half_rhythm"><div>Babies and children on invasive ventilation</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_niceng9er1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</td><td headers="hd_h_niceng9er1.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target oxygen saturation in air at a range of thresholds.</td></tr><tr><td headers="hd_h_niceng9er1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</td><td headers="hd_h_niceng9er1.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target oxygen saturation in air greater than or equal to 92%.</td></tr><tr><td headers="hd_h_niceng9er1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</td><td headers="hd_h_niceng9er1.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Related to admission or discharge
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<ul><li class="half_rhythm"><div>change in respiratory rate</div></li><li class="half_rhythm"><div>change in oxygen saturation</div></li><li class="half_rhythm"><div>reported feeding difficulty</div></li><li class="half_rhythm"><div>readmission rate</div></li></ul>
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Related to management:
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<ul><li class="half_rhythm"><div>length of stay</div></li><li class="half_rhythm"><div>need for high flow humidified oxygen, Continuous positive airway pressure (CPAP) or mechanical ventilation</div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng9er1tab2"><div id="niceng9er1.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573296/table/niceng9er1.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng9er1.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng9er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng9er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng9er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng9er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_niceng9er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng9er1.s1.1.ref1" rid="niceng9er1.s1.1.ref1">Cunningham 2015</a>
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</p>
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<p>RCT</p>
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<p>UK</p>
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</td><td headers="hd_h_niceng9er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Babies ≥6 weeks and ≤12 months of age admitted to hospital with bronchiolitis.</p>
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<p>n=307 in the 90% SpO<sub>2</sub> threshold group.</p>
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<p>n=308 in the 94% SpO<sub>2</sub> threshold group.</p>
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</td><td headers="hd_h_niceng9er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Babies’ oxygen saturation was monitored with modified oximeters. Oxygen saturation of 90% was displayed as 94%. Healthcare professionals would stop supplemental oxygen at a displayed 94% when actual saturation was at 90%.</td><td headers="hd_h_niceng9er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Time to actual discharge.</p>
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<p>Use of nasogastric tube feeding.</p>
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<p>Use of intravenous fluids.</p>
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<p>Need for supplemental oxygen.</p>
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<p>Time to readmission.</p>
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<p>Readmission to hospital within 7 & 28 days.</p>
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<p>High-dependency care.</p>
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<p>Respiratory rate at discharge.</p>
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<p>Mortality.</p>
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<p>Time to cough resolution.<sup>*</sup></p>
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</td></tr><tr><td headers="hd_h_niceng9er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng9er1.s1.1.ref3" rid="niceng9er1.s1.1.ref3">van Hasselt 2020</a>
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</p>
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<p>Prospective observational</p>
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<p>UK</p>
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</td><td headers="hd_h_niceng9er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Babies ≥6 weeks and ≤12 months of age admitted to hospital with bronchiolitis.</p>
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<p>n=162 in the 90% SpO<sub>2</sub> threshold group.</p>
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<p>n=158 in the 92% SpO<sub>2</sub> threshold group.</p>
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</td><td headers="hd_h_niceng9er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 centres were included in the analysis. 6 centres had protocols that specified 90% SpO<sub>2</sub> as a threshold, and 6 that had protocols that specified 92% SpO<sub>2</sub> as a threshold.</td><td headers="hd_h_niceng9er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Length of stay.</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">RCT – randomised controlled trial; SpO<sub>2</sub> – oxygen saturation.</p></div></dd></dl><dl class="bkr_refwrap"><dt>*</dt><dd><div id="niceng9er1.tab2_1"><p class="no_margin">Included even though not a protocol-specified outcome because it was the study’s primary outcome.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng9er1tab3"><div id="niceng9er1.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573296/table/niceng9er1.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng9er1.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><th id="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No. of participants</th><th id="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect estimate (95% CI)</th><th id="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time to actual discharge (hours)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>90% arm: 276</p>
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<p>94% arm: 283</p>
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</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>HR 1.46 (1.23 to 1.73)</p>
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<p>Higher values indicate quicker discharge for 90% arm</p>
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</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medium</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Use of nasogastric tube feeding (no. of events)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>90% arm: 303</p>
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<p>94% arm: 305</p>
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</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.9 (0.7 to 1.1)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medium</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Use of intravenous fluids (no. of events)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>90% arm: 304</p>
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<p>94% arm: 305</p>
|
|
</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.0 (0.6 to 1.6)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Need for supplemental oxygen (no. of events)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90% arm: 304</p>
|
|
<p>94% arm: 305</p>
|
|
</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.8 (0.7 to 0.9)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time to readmission (days)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90% arm: 307</p>
|
|
<p>94% arm: 308</p>
|
|
</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HR 0.93 (0.43 to 1.98)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Readmission to hospital within 7 days (no. of babies)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90% arm: 307</p>
|
|
<p>94% arm: 308</p>
|
|
</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.6 (0.2 to 1.8)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Readmission to hospital within 28 days (no. of babies)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90% arm: 307</p>
|
|
<p>94% arm: 308</p>
|
|
</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.4 (0.2 to 0.7)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High-dependency care (no. of events)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90% arm: 307</p>
|
|
<p>94% arm: 308</p>
|
|
</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.1 (0.5 to 2.6)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Respiratory rate at discharge (breaths per minute)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90% arm: 307</p>
|
|
<p>94% arm: 308</p>
|
|
</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MD 0 (−0.58 to 0.58)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality (no. of events)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90% arm: 307</p>
|
|
<p>94% arm: 308</p>
|
|
</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.2 (0.0 to 3.7)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr><tr><td headers="hd_h_niceng9er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time to cough resolution (days)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90% arm: 307</p>
|
|
<p>94% arm: 308</p>
|
|
</td><td headers="hd_h_niceng9er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median difference 1 (−1 to 2)</td><td headers="hd_h_niceng9er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng9er1tab4"><div id="niceng9er1.tab4" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573296/table/niceng9er1.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng9er1.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_niceng9er1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><th id="hd_h_niceng9er1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No. of participants</th><th id="hd_h_niceng9er1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect estimate (95% CI)</th><th id="hd_h_niceng9er1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><td headers="hd_h_niceng9er1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Length of stay (hours)</td><td headers="hd_h_niceng9er1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90% arm: 181</p>
|
|
<p>94% arm: 139</p>
|
|
</td><td headers="hd_h_niceng9er1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MD −16 (8.47 to −23.53)</p>
|
|
<p>Lower values indicate better outcome for intervention arm.</p>
|
|
</td><td headers="hd_h_niceng9er1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very Low</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng9er1tab5"><div id="niceng9er1.tab5" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573296/table/niceng9er1.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng9er1.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_niceng9er1.tab5_1_1_1_1" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bibr" href="#niceng9er1.s1.1.ref1" rid="niceng9er1.s1.1.ref1">Cunningham 2015</a>
|
|
</th></tr><tr><th headers="hd_h_niceng9er1.tab5_1_1_1_1" id="hd_h_niceng9er1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population & interventions</th><th headers="hd_h_niceng9er1.tab5_1_1_1_1" id="hd_h_niceng9er1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Costs</th><th headers="hd_h_niceng9er1.tab5_1_1_1_1" id="hd_h_niceng9er1.tab5_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th headers="hd_h_niceng9er1.tab5_1_1_1_1" id="hd_h_niceng9er1.tab5_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost effectiveness</th></tr></thead><tbody><tr><td headers="hd_h_niceng9er1.tab5_1_1_1_1 hd_h_niceng9er1.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Population:</b>
|
|
</p>
|
|
<p>Babies between 6 weeks and 12 months with a clinical diagnosis of bronchiolitis who were admitted to hospital.</p>
|
|
<p>
|
|
<b>Interventions</b>
|
|
</p>
|
|
<p>Oxygen saturation target of ≥90% versus an oxygen saturation target of ≥94%.</p>
|
|
</td><td headers="hd_h_niceng9er1.tab5_1_1_1_1 hd_h_niceng9er1.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Cost differences:</b>
|
|
</p>
|
|
<p>
|
|
<u>Total NHS costs (£)</u>
|
|
</p>
|
|
<p><b>90% target:</b> 1612.30</p>
|
|
<p><b>94% target:</b> 1901.83</p>
|
|
<p><b>Difference:</b> −289.53 (95% CI −657, 78)</p>
|
|
</td><td headers="hd_h_niceng9er1.tab5_1_1_1_1 hd_h_niceng9er1.tab5_1_1_2_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Outcome differences:</b>
|
|
</p>
|
|
<p>
|
|
<u>Time to cough resolution (days – complete cases)</u>
|
|
</p>
|
|
<p><b>90% target:</b> 22.35</p>
|
|
<p><b>94% target:</b> 23.13</p>
|
|
<p><b>Difference: −</b>0.78 (95% CI −5.25, 3.69)</p>
|
|
</td><td headers="hd_h_niceng9er1.tab5_1_1_1_1 hd_h_niceng9er1.tab5_1_1_2_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Base-case analysis:</b>
|
|
</p>
|
|
<p>Probability 90% target cost-effective at different willingness-to-pay thresholds for a reduced day to cough resolution:</p>
|
|
<p>
|
|
<b>£0 – 91.5%</b>
|
|
</p>
|
|
<p>
|
|
<b>£25 – 90.3%</b>
|
|
</p>
|
|
<p>
|
|
<b>£50 – 86.5%</b>
|
|
</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng9er1apphtab1"><div id="niceng9er1.apph.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573296/table/niceng9er1.apph.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng9er1.apph.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Code [Reason]</th></tr></thead><tbody><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
American Association for Respiratory Care (2021) AARC Clinical Practice Guideline Management of Pediatric Patients with Oxygen in the Acute Care Setting.
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Duplicate reference</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Angurana, Suresh K.; Takia, Lalit; Williams, Vijai (2020) Acute Viral Bronchiolitis: A Narrative Review. Journal of Pediatric Intensive Care
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Data not reported in an extractable format</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Anonymous. (2017) Erratum: Infants with artificially elevated pulse oximetry levels less likely to be hospitalised during an episode of mild to moderate bronchiolitis (Arch Dis Child Ed Pract (2016) 101 (162-3) DOI: 10.1136/archdischild-2016-310570). Archives of Disease in Childhood: Education and Practice Edition
|
|
102(1): 54 [<a href="https://pubmed.ncbi.nlm.nih.gov/27075718" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27075718</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Secondary publication of an included study that does not provide any additional relevant information</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
BMJ Best Practice (2020) Bronchiolitis.
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Guidelines</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Boyd, K, McIntosh, E, Lewis, S
|
|
et al. (2015) Cost-effective management of bronchiolitis in infants: 90% versus 94% oxygen saturation. European respiratory journal
|
|
46(suppl59): oa1988
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Canadian Paediatric Society (2018) Use of high-flow nasal cannula oxygen therapy in infants and children. [<a href="/pmc/articles/PMC6241947/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6241947</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31043841" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31043841</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain a relevant intervention</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Canadian Paediatric Society (2014) Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age Updated 2018. [<a href="/pmc/articles/PMC4235450/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4235450</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25414585" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25414585</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Guidelines</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Clinical Knowledge Summaries (2021) Cough - acute with chest signs in children: bronchiolitis.
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Not a relevant study design</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Colombo, Jacopo, Gattoni, Chiara, Nacoti, Mirco
|
|
et al. (2020) Risk factors for intubation in severe bronchiolitis: a useful tool to decide on an early intensive respiratory support. Minerva pediatrica [<a href="https://pubmed.ncbi.nlm.nih.gov/32493000" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32493000</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Study does not contain a relevant intervention</p>
|
|
<p>Oxygen saturation measured as a dichotomous variable, above and below 75%.</p>
|
|
<p>- Not a relevant study design</p>
|
|
<p>Preprint</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Coskun, Yesim, Saglam, Filiz, Mamal-Torun, Muzeyyen
|
|
et al. (2017) Risk factors for intensive care need in children with bronchiolitis: A case-control study. The Turkish journal of pediatrics
|
|
59(5): 520–523 [<a href="https://pubmed.ncbi.nlm.nih.gov/29745112" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29745112</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Not a relevant study design</p>
|
|
<p>Case-control study with cross-sectional data.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Cunningham, Steve (2018) Respiratory Support in Bronchiolitis: Trial Evidence. American journal of perinatology
|
|
35(6): 553–556 [<a href="https://pubmed.ncbi.nlm.nih.gov/29694995" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29694995</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Not a relevant study design</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Cunningham, Steve (2020) Critical Care Thresholds in Children with Bronchiolitis. American journal of perinatology
|
|
37(s02): 42–s45 [<a href="https://pubmed.ncbi.nlm.nih.gov/32898881" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32898881</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Not a relevant study design</p>
|
|
<p>Literature review not a study.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Department for Health and Wellbeing GOSA (2018) Bronchiolitis in Children.
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Guidelines</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fernandes, Ricardo M; Plint, Amy C; Terwee, Caroline B; Sampaio, Cristina; Klassen, Terry P; Offringa, Martin; van der Lee, Johanna H (2015) Validity of bronchiolitis outcome measures. Paediatrics
|
|
135:6
|
|
e1399–408 [<a href="https://pubmed.ncbi.nlm.nih.gov/25986025" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25986025</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Study does not contain a relevant intervention</p>
|
|
<p>Does not assess oxygen saturation or compare two different oxygen saturation levels.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Franklin, Donna, Hasan, Nadia, Kapoor, Vishal
|
|
et al. (2019) Nasal High Flow in Room Air for Hypoxemic Bronchiolitis Infants. Frontiers in Pediatrics
|
|
7: 426 [<a href="/pmc/articles/PMC6823186/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6823186</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31709201" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31709201</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain a relevant intervention</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Freire, Gabrielle, Kuppermann, Nathan, Zemek, Roger
|
|
et al. (2018) Predicting Escalated Care in Infants With Bronchiolitis. Pediatrics
|
|
142(3) [<a href="https://pubmed.ncbi.nlm.nih.gov/30705143" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30705143</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Comparator in study does not match that specified in protocol</p>
|
|
<p>No comparison with 92% oxygen saturation.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hendaus, Mohamed A.; Alhammadi, Ahmed H.; Jomha, Fatima A. (2015) Pulse oximetry in bronchiolitis: Is it needed?. Therapeutics and Clinical Risk Management
|
|
11: 1573–1578 [<a href="/pmc/articles/PMC4608625/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4608625</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26491341" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26491341</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Data not reported in an extractable format</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kaditis, Athanasios G, Katsouli, Georgia, Malakasioti, Georgia
|
|
et al. (2015) Infants with viral bronchiolitis demonstrate two distinct patterns of nocturnal oxyhaemoglobin desaturation. Acta paediatrica (Oslo, Norway : 1992)
|
|
104(3): e106–11 [<a href="https://pubmed.ncbi.nlm.nih.gov/25492521" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25492521</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Study does not contain a relevant intervention</p>
|
|
<p>Compares oxygen saturation in children with bronchiolitis, partial upper airway obstruction, and controls</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
King, David; Dicks, Rebecca Amy; Wacogne, Ian D (2016) Infants with artificially elevated pulse oximetry levels less likely to be hospitalised during an episode of mild to moderate bronchiolitis. Archives of disease in childhood. Education and practice edition
|
|
101(3): 162–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/27075718" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27075718</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Not a relevant study design</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kirolos, Amir, Manti, Sara, Blacow, Rachel
|
|
et al. (2020) A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis. The Journal of infectious diseases
|
|
222(suppl7): 672–s679 [<a href="https://pubmed.ncbi.nlm.nih.gov/31541233" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31541233</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Guidelines</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Luarte-Martinez, Soledad; Rodriguez-Nunez, Ivan; Astudillo, Paula (2019) Validity and reliability of the modified Tal score in Chilean children. A multicenter study. Archivos argentinos de pediatria
|
|
117(4): e340–e346 [<a href="https://pubmed.ncbi.nlm.nih.gov/31339270" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31339270</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Comparator in study does not match that specified in protocol</p>
|
|
<p>Study uses oxygen saturation as a reference standard. There was no comparison between different saturation levels.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mansbach, Jonathan M, Clark, Sunday, Piedra, Pedro A
|
|
et al. (2015) Hospital course and discharge criteria for children hospitalized with bronchiolitis. Journal of hospital medicine
|
|
10(4): 205–11 [<a href="/pmc/articles/PMC4390446/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4390446</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25627657" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25627657</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Comparator in study does not match that specified in protocol</p>
|
|
<p>Does not compare oxygen saturation levels. Description of outcomes after new discharge criteria were used.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Martin, Shirley; Martin, Jennifer; Seigler, Theresa (2015) Evidence-Based Protocols to Guide Pulse Oximetry and Oxygen Weaning in Inpatient Children with Asthma and Bronchiolitis: A Pilot Project. Journal of pediatric nursing
|
|
30(6): 888–95 [<a href="https://pubmed.ncbi.nlm.nih.gov/25707869" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25707869</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Comparator in study does not match that specified in protocol</p>
|
|
<p>Follows the development of local guidelines for weaning children from oxygen and at which oxygen saturations this is safe to do. Comparison between before and after guidelines were used but unknown what the oxygen saturation threshold was before guideline implementation.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Masarweh, Kamal, Gur, Michal, Leiba, Ronit
|
|
et al. (2020) Factors predicting length of stay in bronchiolitis. Respiratory medicine
|
|
161: 105824 [<a href="https://pubmed.ncbi.nlm.nih.gov/31759271" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31759271</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Study does not contain a relevant intervention</p>
|
|
<p>Did not assess oxygen saturation.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mayor, Susan (2016) Reduced oxygen saturation is not linked to repeat hospital visits in infant bronchiolitis. BMJ (Clinical research ed.)
|
|
352 [<a href="https://pubmed.ncbi.nlm.nih.gov/26936385" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26936385</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Not a relevant study design</p>
|
|
<p>Commentary on the area and not a study.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Meenaghan, S; Breatnach, C; Smith, H (2020) Risk Factors for Respiratory Syncytial Virus Bronchiolitis Admissions. Irish medical journal
|
|
113(1): 9 [<a href="https://pubmed.ncbi.nlm.nih.gov/32298565" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32298565</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Study does not contain a relevant intervention</p>
|
|
<p>Does not assess oxygen saturation levels.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mendlowitz, Andrew B, Widjaja, Elysa, Phan, Cathy
|
|
et al. (2018) A Cost Analysis of Pulse Oximetry as a Determinant in the Decision to Admit Infants With Mild to Moderate Bronchiolitis. Pediatric emergency care [<a href="https://pubmed.ncbi.nlm.nih.gov/30601347" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30601347</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Health economics</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Napolitano, Natalie, Berlinski, Ariel, Walsh, Brian K.
|
|
et al. (2021) AARC Clinical Practice Guideline Management of Pediatric Patients with Oxygen in the Acute Care Setting. Respiratory care [<a href="https://pubmed.ncbi.nlm.nih.gov/33790048" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33790048</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Guidelines</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
NHS Children’s Acute Transport Service (2020) Clinical Guidelines - Bronchiolitis.
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Not a relevant study design</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
NSW Government (2018) Infants and Children - Acute Management of Bronchiolitis.
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Guidelines</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ohlsen, Timothy J D, Knudson, Alexander M, Korgenski, E Kent
|
|
et al. (2021) Nine Seasons of a Bronchiolitis Observation Unit and Home Oxygen Therapy Protocol. Journal of hospital medicine
|
|
16(5): 261–266 [<a href="/pmc/articles/PMC8086993/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8086993</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33929945" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33929945</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Study does not contain a relevant intervention</p>
|
|
<p>The OU-HOT intervention is an at home oxygen delivery system. The study did not compare outcomes based on oxygen saturation levels.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Praznik, Ajda, Vinsek, Neza, Prodan, Ana
|
|
et al. (2018) Risk factors for bronchiolitis severity: A retrospective review of patients admitted to the university hospital from central region of Slovenia. Influenza and other Respiratory Viruses
|
|
12(6): 765–771 [<a href="/pmc/articles/PMC6185887/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6185887</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29944781" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29944781</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Study does not contain a relevant intervention</p>
|
|
<p>Did not report oxygen saturation.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Principi, Tania, Coates, Allan L, Parkin, Patricia C
|
|
et al. (2016) Effect of Oxygen Desaturations on Subsequent Medical Visits in Infants Discharged From the Emergency Department With Bronchiolitis. JAMA pediatrics
|
|
170(6): 602–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/26928704" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26928704</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Comparator in study does not match that specified in protocol</p>
|
|
<p>Only compares infants with desaturations <90% to infants with no desaturations below that point.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ralston, Shawn L., Lieberthal, Allan S., Meissner, H. Cody
|
|
et al. (2014) Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics
|
|
134(5): e1474–e1502 [<a href="https://pubmed.ncbi.nlm.nih.gov/25349312" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25349312</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Guidelines</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rebnord, Ingrid Keilegavlen, Sandvik, Hogne, Hunskaar, Steinar
|
|
et al. (2017) Factors predicting antibiotic prescription and referral to hospital for children with respiratory symptoms: Secondary analysis of a randomised controlled study at out-of-hours services in primary care. BMJ Open
|
|
7(1): e012992 [<a href="/pmc/articles/PMC5253552/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5253552</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28096254" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28096254</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain a relevant intervention</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rojas-Reyes, Maria Ximena; Granados Rugeles, Claudia; Charry-Anzola, Laura Patricia (2014) Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age. The Cochrane database of systematic reviews: cd005975 [<a href="/pmc/articles/PMC6464960/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6464960</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25493690" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25493690</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain a relevant intervention</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Royal Children’s Hospital Melbourne (2020) Clinical Practice Guidelines - Bronchiolitis.
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Guidelines</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Royal College of Paediatrics and Child Health (2020) National guidance for the management of children with bronchiolitis and lower respiratory tract infections during COVID-19 Last modified 24 May 2021.
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Guidelines</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Schuh, Suzanne, Freedman, Stephen, Coates, Allan
|
|
et al. (2014) Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA
|
|
312(7): 712–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/25138332" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25138332</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Already looked at by NG9 guideline</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Slain, Katherine N, Rotta, Alexandre T, Martinez-Schlurmann, Natalia
|
|
et al. (2019) Outcomes of Children With Critical Bronchiolitis Meeting at Risk for Pediatric Acute Respiratory Distress Syndrome Criteria. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|
|
20(2): e70–e76 [<a href="https://pubmed.ncbi.nlm.nih.gov/30461577" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30461577</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Study does not contain a relevant intervention</p>
|
|
<p>Compares children with severe disease to children with mild disease.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Stollar, Fabiola, Glangetas, Alban, Luterbacher, Fanny
|
|
et al. (2020) Frequency, Timing, Risk Factors, and Outcomes of Desaturation in Infants With Acute Bronchiolitis and Initially Normal Oxygen Saturation. JAMA network open
|
|
3(12): e2030905 [<a href="/pmc/articles/PMC7758807/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7758807</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33355677" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33355677</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain a relevant intervention</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Suessman, Anna, Gray, Lauren L, Cavenaugh, Sarah
|
|
et al. (2020) Clinical factors associated with intubation in the high flow nasal cannula era. The American journal of emergency medicine
|
|
38(12): 2500–2505 [<a href="https://pubmed.ncbi.nlm.nih.gov/31948785" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31948785</span></a>]
|
|
</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>- Study does not contain a relevant intervention</p>
|
|
<p>Oxygen saturation not reported.</p>
|
|
<p>- Not a relevant study design</p>
|
|
<p>Cross-sectional study.</p></td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Vincent, Jennifer Orr; Lo, Huay-Ying; Wu, Susan (2017) Bronchiolitis Care in the Hospital. Reviews on recent clinical trials
|
|
12(4): 246–252 [<a href="https://pubmed.ncbi.nlm.nih.gov/28814254" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28814254</span></a>]
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</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Data not reported in an extractable format</td></tr><tr><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Zorc, Joseph J. (2015) Randomised controlled trial: Pulse oximetry may lead to unnecessary hospital admissions for infants with bronchiolitis and mild hypoxaemia. Evidence-Based Medicine
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20(1): 19 [<a href="https://pubmed.ncbi.nlm.nih.gov/25550482" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25550482</span></a>]
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</td><td headers="hd_h_niceng9er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Not a relevant study design</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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