Avoid performing chest X-rays or repeated blood tests in bronchiolitis. Discontinue oxygen therapy and pulse oximetry when SpO₂ is >90% in room air

Rationale:

A thorough medical history and physical examination provide an accurate assessment of the severity of bronchiolitis. Routine chest X-rays, repeated blood tests, and continuous pulse oximetry are unnecessary unless there is suspicion of respiratory failure or secondary bacterial infection.  

Oxygen therapy should be discontinued once SpO₂ remains above 90% and the child's overall condition is stable. 

References:

• Diagnosis and management of bronchiolitis. Pediatrics 2006, 118, 1774-93.
• Akenroye, A.T., Baskin, M.N., Samnaliev, M. & Stack, A.M. Impact of bronchiolitis guideline on ED resource use and cost: a segmented time-series analysis. Pediatrics 2014, 133, e227-34.
• Ralston, S.L. et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014, 134, e1474-502.
• Ralston, S.L. et al. A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis. Pediatrics 2016, 137.
• Skjerven, H.O. et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. N Engl J Med 2013, 368, 2286-93.
• Quinonez, R.A. et al. When technology creates uncertainty: pulse oximetry and overdiagnosis of hypoxaemia in bronchiolitis BMJ 2017