Feature The BMJ Awards 2016

UK research paper of the year

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2211 (Published 25 April 2016) Cite this as: BMJ 2016;353:i2211
  1. Nigel Hawkes, freelance journalist
  1. London, UK
  1. nigel.hawkes1{at}btinternet.com

All the nominations in this category have the potential to change clinical practice, reports Nigel Hawkes

Oxygen saturation targets in infants with bronchiolitis

Bronchiolitis is a common infection in infants, often caused by respiratory syncytial virus. A minority of children require admission to hospital, where oxygen levels are monitored and supplemental oxygen provided if oxygen saturation falls below a threshold. The question is: where should that threshold lie?

Steve Cunningham of the department of child life and health at Edinburgh University and colleagues designed a double blind trial in which infants were randomised to targets of 90% or 94% oxygen saturation.1 “That sounds a small difference but it captures a lot of patients,” he says. “We wanted to know what it means in terms of outcomes if you go for 90% rather than 94%. The other question is what does it mean for services?”

The answer is that there is no clinical difference. Time to resolution of cough—the primary outcome—was the same in both groups. “The other outcomes were better in the lower oxygen group,” he says. “The kids started feeding sooner and the parents’ perception, which is pretty important, was that the kids got better sooner.” This suggests that higher oxygen levels may be detrimental, possibly because they speed virus replication.

The findings have service implications because they mean that fewer patients will require supplemental oxygen and in those who do the time it is needed is reduced from 27.6 hours to 5.7 hours. For paediatric hospitals bronchiolitis is a huge issue every winter. “There’s a six-week period, between mid-November and the end of December, when the whole thing is gridlocked,” Cunningham says. A lower oxygen threshold can reduce that pressure and in future may enable oxygen at home rather than in hospital—as is already done in some places …

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