Automated oxygen kept bronchiolitic infants on target but did not shorten their stay

Design

Multicentre randomised controlled trial

Population

103 infants aged 1–12 months with non-severe bronchiolitis needing oxygen, in France

Primary outcome

Length of hospital stay

Effect

Median 71.0 vs 69.6 hours (p=0.39); time in target 89.4% vs 74.9%

A French multicentre trial randomised 103 infants aged 1–12 months, admitted with non-severe bronchiolitis and saturations below 92%, to closed-loop automated oxygen delivery or conventional manual titration.

Median stay was similar: 71.0 hours with the automated system and 69.6 hours with manual titration (p=0.39). Infants on automated delivery spent more time within the target saturation range (89.4% vs 74.9%) and received lower oxygen flows (median 0.1 vs 0.3 L/min). Readmission and the need for non-invasive ventilation did not differ.

The trial ran over five years and recruited fewer infants than intended, so it may have missed a modest effect on stay. The clearer lesson is how much time manually titrated infants spent outside target — a reminder that oxygen in bronchiolitis needs active weaning.

• Wean oxygen actively in bronchiolitis; manually titrated infants spent a quarter of the time outside target.
• Set and document a target saturation range for each infant on oxygen.
• Automated titration did not shorten stay here, so it is not a reason to change equipment on its own.
• Readmissions were no different, so tighter oxygen control did not trade off safety.

Why it matters

Oxygen is often the only thing keeping a bronchiolitic infant in hospital, and it is easy to leave running.

Don't overread it

Under-recruitment means the trial cannot exclude a modest effect on length of stay.

The statistics, in plain English

A p value of 0.39 for length of stay means no difference was detected. With only 103 infants, the trial was too small to rule out a modest effect either way.

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