Adrian Zurca, MD,
Associate Professor of Pediatrics
Penn State Milton S. Hershey Medical Center
Hershey, Pennsylvania
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.
Steven Shein, MD, FCCM
Rainbow Babies & Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Title: Intensivists Agree: Additional Guidelines Needed for Critical Bronchiolitis
Introduction: Acute viral bronchiolitis is the most common reason for admission to the pediatric intensive care unit (PICU). Current bronchiolitis guidelines focus on minimizing diagnostic and therapeutic interventions, however, do not include consideration of infants with critical bronchiolitis, including infants that require invasive mechanical ventilation.
Methods: A survey was developed by a group of critical bronchiolitis researchers to evaluate management of infants less than 12 months of age admitted to the PICU with bronchiolitis. IRB approval was obtained. The survey was distributed electronically in English, Spanish and Portuguese to an international group of pediatric intensivists. Descriptive analyses were generated. Chi-square was used to compare frequency with which participants reported using various diagnostic and therapeutic modalities at least 25% of the time.
Results: 657 people responded to the survey, of which 344 (52%) were in English, 204 (31%) in Spanish and 109 (17%) in Portuguese. Respondents were mostly (79%) PICU attendings, with a median of 10 years of experience (IQR: 5, 18). On admission, participants are significantly more likely to obtain a chest x-ray for intubated vs. non-intubated patients (98% intubated vs. 83% non-intubated, P < 0.001). Participants are also significantly more likely to obtain laboratory tests on admission for intubated vs. non-intubated patients (Blood culture: 72% vs. 32%, basic metabolic panel: 92% vs. 64%, complete blood count: 97% vs. 75%, liver function tests 57% vs. 30%; all P < 0.001). Short-acting beta-2 agonists (SAB), systemic steroids, antibiotics and chest physiotherapy are all more commonly used in intubated vs. non-intubated patients (SAB: 50% vs. 43%, P = 0.035; steroids: 33% vs. 22%, P < 0.001; antibiotics: 52% vs. 24%, P < 0.001; physiotherapy: 78% vs 68%, < 0.001). The majority of respondents felt it would be beneficial to have treatment guidelines for infants with bronchiolitis requiring non-invasive (91%) and invasive respiratory support (89%).
Conclusions: Diagnostic and therapeutic modalities for infants with critical bronchiolitis are used beyond what is recommended by published bronchiolitis guidelines, especially for intubated patients. Specific guidelines for management of infants with critical bronchiolitis are needed.