Bryan Combs, MD
Rainbow Babies and Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Steven Shein, MD, FCCM
Rainbow Babies & Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Sebastian Gonzalez-Dambrauskas, MD
Attending Physician
LA Red Network, United States
Disclosure information not submitted.
Jose Colleti Junior, MD, PhD
Hospital Assunção Rede D'Or
São Paulo, Brazil
Disclosure information not submitted.
PABLO VASQUEZ-HOYOS, MD
Attending Physician
Universidad Nacional De Colombia, United States
Disclosure information not submitted.
Lee Jan Hau, MBBS, MRCPCH, MCI (he/him/his)
KK Women's and Children's Hospital, Singapore
Singapore, Slovenia
Disclosure information not submitted.
Donna Franklin, PhD
Researcher
Gold Coast University Hospital Children's Critical Care Research Group, United States
Disclosure information not submitted.
Steven Pon, MD, FCCM
Attending Physician
New York-Presbyterian Hospital/Weill Cornell Medical Center, United States
Disclosure information not submitted.
Todd Karsies, MD
Attending Physician
Nationwide Children's Hospital At Ohio State University, United States
Disclosure information not submitted.
Adrian Zurca, MD,
Associate Professor of Pediatrics
Penn State Milton S. Hershey Medical Center
Hershey, Pennsylvania
Disclosure information not submitted.
Title: Reported Practices for Children with Critical Bronchiolitis Differ Based on Clinician Experience
Introduction: Acute viral bronchiolitis is the most common reason for admission to the pediatric intensive care unit (PICU); however, no comprehensive evidence-based guidelines for management of critical bronchiolitis exist. There are a wide range of practice patterns for bronchiolitis, and provider experience may influence practice.
Methods: A survey was developed to describe contemporary management of infants 2 to 12 months of age admitted to the PICU with bronchiolitis. The survey was distributed electronically to an international group of pediatric intensivists in English, Spanish and Portuguese. Responses stating usage ≥75% of the time defined usage of the queried practice. Chi squared was used to compare less experienced (fewer than 10 years in practice) vs. more experienced (10 years or greater) providers.
Results: 657 people responded to the survey, of which 46% were less experienced and 34% were more experienced; respondents not reporting experience were excluded from analysis. In intubated patients, less experienced providers were more likely to prescribe antibiotics (29% vs. 17%, p = 0.003), perform a venous blood gas on admission (95% vs. 88%, p = 0.021), administer short-acting beta agonists (32% vs. 22%, p = 0.017), and obtain daily chest radiographs (64% vs. 53%, p = 0.021), and less likely to provide enteral nutrition (78% vs. 86%, p = 0.032). In non-intubated patients, less experienced providers were more likely to place a peripheral IV (84% vs. 76%, p = 0.023) and use nasal suctioning (80% vs. 69%, p = 0.011). They were more likely to feed while using high flow nasal cannula (93% vs. 87%, p = 0.038), but less likely to do so on non-invasive ventilation (66% vs. 80%, p < 0.001). There were no differences between groups in obtaining a chest radiograph upon admission (whether intubated or not) or in performing basic laboratory work, including complete blood cell counts, c-reactive protein, and electrolytes.
Conclusions: There are variable approaches to managing critical bronchiolitis, with differences in common practices between more and less experienced providers. Despite this relatively common reason for admission to the PICU, there is a paucity of evidenced-based practice guidelines. Further studies should seek to better elucidate the utility of common approaches to critical bronchiolitis.