Format

Send to

Choose Destination
Emerg Med Australas. 2017 Aug;29(4):421-428. doi: 10.1111/1742-6723.12778. Epub 2017 May 19.

Intensive care unit admissions and ventilation support in infants with bronchiolitis.

Oakley E1,2,3, Chong V1, Borland M4,5, Neutze J6, Phillips N7,8,9, Krieser D2,3,10, Dalziel S11,12, Davidson A2,3,13, Donath S2,3, Jachno K2, South M2,3,14, Fry A1,2, Babl FE1,2,3.

Author information

1
Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
2
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
3
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
4
Department of Emergency Medicine, Princess Margaret Hospital, Perth, Western Australia, Australia.
5
School of Paediatrics and Child Health and School of Primary, Rural and Aboriginal Health, The University of Western Australia, Perth, Western Australia, Australia.
6
Department of Emergency Medicine, Kidz First Hospital Middlemore, Auckland, New Zealand.
7
Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
8
Children's Health Research Centre, The University of Queensland Medical Research Institute, Brisbane, Queensland, Australia.
9
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
10
Department of Emergency Medicine, Sunshine Hospital, Melbourne, Victoria, Australia.
11
Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
12
Liggins Institute, The University of Auckland, Auckland, New Zealand.
13
Department of Anaesthesia, Royal Children's Hospital, Melbourne, Victoria, Australia.
14
Department of Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.

Abstract

OBJECTIVES:

To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis.

DESIGN:

Retrospective review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2-12 months old admitted with bronchiolitis.

SETTING:

Seven Australian and New Zealand hospitals. These infants were prospectively identified through the comparative rehydration in bronchiolitis (CRIB) study between 2009 and 2011.

RESULTS:

Of 3884 infants identified, 3589 charts were available for analysis. Of 204 (5.7%) infants with bronchiolitis admitted to ICU, 162 (79.4%) received ventilation support. Of those 133 (82.1%) received non-invasive ventilation (high flow nasal cannula [HFNC] or continuous positive airway pressure [CPAP]) 7 (4.3%) received invasive ventilation alone and 21 (13.6%) received a combination of ventilation modes. Infants with comorbidities such as chronic lung disease (OR 1.6 [95% CI 1.0-2.6]), congenital heart disease (OR 2.3 [1.5-3.5]), neurological disease (OR 2.2 [1.2-4.1]) or prematurity (OR 1.5 [1.0-2.1]), and infants 2-6 months of age (OR 1.5 [1.1-2.0]) were more likely to be admitted to ICU. Respiratory syncitial virus positivity did not increase the likelihood of being admitted to ICU (OR 1.1 [95% CI 0.8-1.4]). HFNC use changed from 13/53 (24.5% [95% CI 13.7-38.3]) patient episodes in 2009 to 39/91 (42.9% [95% CI 32.5-53.7]) patient episodes in 2011.

CONCLUSION:

Admission to ICU is an uncommon occurrence in infants admitted with bronchiolitis, but more common in infants with comorbidities and prematurity. The majority are managed with non-invasive ventilation, with increasing use of HFNC.

KEYWORDS:

bronchiolitis; continuous positive airway pressure; high flow nasal cannula; intensive care unit; intubation; non-invasive ventilation

PMID:
28544539
DOI:
10.1111/1742-6723.12778
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center