Pediatric anesthesia & critical care
Respiratory Support Practices for Bronchiolitis in the Pediatric Intensive Care Unit
Authors' conclusion
Findings of this cross-sectional study of patients aged younger than 2 years admitted for bronchiolitis suggest there was a 3-fold increase in PICU admissions between 2013 and 2022 associated with a 4.8-fold increase in HFNC use and a 5.8-fold increase in NIV use.
Study context
- Population
- Patients aged <2 years admitted to 27 pediatric intensive care unit (PICUs) for bronchiolitis, 2013–2022encounters, 27 PICUs
- Participants
- 33,816 patients
- Outcome
- Number of PICU admissions for bronchiolitis requiring HFNC, NIV or IMV
Methodological detailsmulticentre database (Virtual Pediatric Systems)
- Multicentre database (Virtual Pediatric Systems)
Main finding
As reported in the abstract
PICU admissions increase, encounters annually
350
95% CI 170–531
High-flow nasal cannula (HFNC) use increase, encounters per year
242
95% CI 139–345
Noninvasive ventilation (NIV) use increase, encounters per year
126
95% CI 64–189
Invasive mechanical ventilation (IMV) use, no significant change, encounters per year
10
95% CI −11 to 31
Observational data: associations, not effects.
Further findings
HFNC outcomes
- Successfully weaned from HFNC, 22 381 patients
- 81.8%
- Restarted on HFNC, 431
- 1.6%
- Escalated to NIV, 3057
- 11.2%
- Escalated to IMV or extracorporeal membrane oxygenation (ECMO), 1476
- 5.4%
- Successful HFNC 2013, 820 of 1027
- 79.8%
- Successful HFNC 2022, 3693 of 4399 (P = .002)
- 84.0%
NIV outcomes
- Successfully weaned from NIV, 8476 patients
- 81.5%
- Restarted on NIV, 787
- 7.6%
- Escalated to IMV or ECMO, 1135
- 10.9%
- NIV success 2013, 224 of 306
- 73.2%
- NIV success 2022, 1335 of 1589 (P < .001)
- 84.0%
Factors associated with HFNC and NIV failure (multivariable logistic regression)
- Lower weight, higher Pediatric Risk of Mortality III score, cardiac disease and PICU admission from outside the ED associated with greater odds of HFNC and NIV failure
Original publication
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