Original ArticlesVariability of Care in Infants with Severe Bronchiolitis: Less-Invasive Respiratory Management Leads to Similar Outcomes
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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Cited by (37)
Trials and Tribulations in Bronchiolitis
2022, Journal of PediatricsHas the introduction of high-flow nasal cannula modified the clinical characteristics and outcomes of infants with bronchiolitis admitted to pediatric intensive care units? A retrospective study
2021, Archives de PediatrieCitation Excerpt :Many factors could contribute to this observation but the findings confirm the important roles of NIV and HFNC in the management of severe bronchiolitis [18], despite the relative lack of robust data (i.e., randomized control trial) supporting their use [15]. Recently, Essouri et al. showed that less invasive management, including the use of NIV instead of invasive ventilation, resulted in similar outcomes but with fewer complications [19]. Overall, we confirmed that although severe bronchiolitis can lead to acute respiratory failure and renewed PICU admission, patients usually had positive outcomes.
Respiratory support for infants with bronchiolitis, a narrative review of the literature
2019, Paediatric Respiratory ReviewsCitation Excerpt :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.
The authors declare no conflicts of interest.