Elsevier

The Journal of Pediatrics

Volume 188, September 2017, Pages 156-162.e1
The Journal of Pediatrics

Original Articles
Variability of Care in Infants with Severe Bronchiolitis: Less-Invasive Respiratory Management Leads to Similar Outcomes

https://doi.org/10.1016/j.jpeds.2017.05.033Get rights and content

Objective

To compare the management of children with severe bronchiolitis requiring intensive care (based on duration of ventilatory support and duration of pediatric intensive care unit [PICU] stay) in 2 countries with differing pediatric transport and PICU organizations.

Study design

This was a prospective observational care study in 2 PICUs of tertiary care university hospitals, 1 in France and 1 in Canada. All children with bronchiolitis who required admission to the PICU between November 1, 2013, and March 31, 2014, were included.

Results

A total of 194 children were included. Baseline characteristics and illness severity were similar at the 2 sites. There was a significant difference between centers in the use of invasive ventilation (3% in France vs 26% in Canada; P < .0001). The number of investigations performed from admission to emergency department presentation and during the PICU stay was significantly higher in Canada for both chest radiographs and blood tests (P < .001). The use of antibiotics was significantly higher in Canada both before (60% vs 28%; P < .001) and during (72% vs 33%; P < .0001) the PICU stay. The duration of ventilatory support, median length of stay, and rate of PICU readmission were similar in the 2 centers.

Conclusion

Important differences in the management of children with severe bronchiolitis were observed during both prehospital transport and PICU treatment. Less invasive management resulted in similar outcomes with in fewer complications.

Section snippets

Methods

We performed a prospective bicentric observational study at 1 French center and 1 Canadian center. The Canadian patients were recruited from the PICU of Centre Hospitalier Universitaire (CHU) Sainte Justine in Montréal, a tertiary care center with 24 specialized pediatric beds and 900-1000 admissions annually. The French patients, were recruited from the PICU of CHU Kremlin Bicêtre (France), a tertiary care center with 20 specialized pediatric beds and more than 800 admissions annually. No

Results

Data for all children who met our inclusion criteria were collected. The 194 children included 137 patients in the French center (center 1) and 57 patients in the Canadian center (center 2). The number of admitted patients was comparable in the 2 centers when considering the hospital catchment populations. In center 1, the hospital catchment population per PICU was 2 396 000, of which the patients admitted for bronchiolitis represented 0.57% (iledefrance.fr). In center 2, the hospital catchment

Discussion

The optimal management of severe viral bronchiolitis remains a matter of debate, with significant variation in the management of patients requiring intensive care, as noted in previous studies.14 The recent recommendations from the American Academy of Pediatrics,15 the Canadian Paediatric Society, and the National Institute for Health and Care Excellence highlight the positive impact of reducing diagnostic testing, medications, and interventions in the management of standard viral bronchiolitis.

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      A large retrospective study describes a high safety standard for the use of NHF therapy during transport of infants with bronchiolitis [30]. Two recent reports described the variability of intensive care practice in infants with bronchiolitis [31,32]. The larger Australian and New Zealand registry study showed high variability in practice with some hospitals preferentially invasively ventilating infants with bronchiolitis, a practice that remained variable after risk adjustment.

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    The authors declare no conflicts of interest.

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