393 - Variation and Differences in Room Air Challenges

Poster Number: 393
Publication Number: 393.243

Melissa Wong, University of Colorado, Denver, CO, United States; Alexandra C. Collell, University of Colorado School of Medicine, Denver, CO, United States; Mariana Nino de Guzman Ramirez, Children's Hospital Colorado, Denver, CO, United States; Carly G. Muller, Children's Hospital Colorado, Denver, CO, United States; Erica R. Poe, University of Colorado School of Medicine, Denver, CO, United States; Sheridan Schulte, University of Colorado School of Medicine, Denver, CO, United States; Amy Tyler, University of Colorado School of Medicine, Aurora, CO, United States; Michael Tchou, Children's Hospital Colorado, Aurora, CO, United States; Jillian M. Cotter, University of Colorado School of Medicine, Aurora, CO, United States

Background: Room air challenge (RAC) is a common practice for children with respiratory infections who are weaning supplemental oxygen therapy. It is unclear how they are performed in practice.

Objective: The aim of this study is to describe RAC practice variation and evaluate differences in RAC among children discharged with or without home oxygen.

Design/Methods: We conducted a retrospective cohort study of children 2 months to 2 years of age who were hospitalized from 10/2019 to 3/2020 at a quaternary care children’s hospital with a diagnosis of bronchiolitis (ICD-10: J21.x) and received oxygen. Children on home oxygen prior to admission, complex chronic conditions, and preterm infants were excluded. A chart review of 5% of the overall population was performed to examine details of RAC practices (awake vs asleep, number of RAC performed, and oxygen saturation level documented as failure, defined as the value prior to a patient being placed back on oxygen after a RAC attempt during hospitalization). RAC practices were compared between those discharged with and without oxygen using Pearson’s chi squared and Wilcoxon rank sum tests.

Results: Of 1310 children, 24% were discharged with oxygen. We conducted a chart review on 60 patients who had a total of 208 RAC (Table 1). Documentation of RAC varied in terms of degree of documentation (Table 2). Seventy-two percent of children were asleep during the RAC. When comparing children discharged with or without oxygen, there was no difference in whether RAC were performed while sleeping vs awake (p=0.47). There was a median of 2 RAC per child (IQR 1,3) with a range of 1-15 per child. Patients discharged with oxygen had more RAC compared to those who did not (median 3.5 [IQR 2,6] vs 1[1-2], p< 0.01). Seventy-six percent of RAC failed; the median oxygen saturation value for failed RAC was 84% (IQR 82, 86) with a range of 26-97%, and passed RAC was 92% (IQR 91, 95) with range of 84-100%. Those who were discharged with oxygen had no difference in median oxygen saturation values determined to be a failed RAC compared to those who were discharged on room air (p=0.07).Conclusion(s): Inconsistencies exist in the documentation of RAC in hospitalized patients with bronchiolitis. There is wide variability in the number of RAC performed per patient and overlap in oxygen saturation levels determined to be passed or failed amongst patients. There were no major differences in RAC practices for children with or without oxygen. Opportunities exist for improving the RAC process, including standard definitions for what is considered a failure and best practices for how to perform a RAC.
Table 1: Characteristics of Chart Reviewed Population
Table 2: Frequency of Unknown in RAC Variables