Bronquiolitis grave. Cambios epidemiológicos y de soporte respiratorio

Oñoro, Gonzalo; Suárez, Esther Pérez; Bouzas, M.I. Iglesias; Serrano, Alicia; Azagra, Amelia Martínez de; Teresa, María; Flores, Juan

doi:10.1016/j.anpedi.2011.01.012

Cited by 20 publications

(9 citation statements)

References 23 publications

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“…A wide variability exists in the use of different respiratory support techniques among countries 6,7 and even within the same country. 8,9 There is a lack of knowledge about the real value of each tool available for the management of respiratory failure in bronchiolitis. Recently, randomized controlled trials showed that early and generalized use of HFNC in mild-moderate bronchiolitis slightly reduced the percentage of pediatric ICU admissions.…”

Section: Introductionmentioning

confidence: 99%

Comparison in the Management of Respiratory Failure due to Bronchiolitis in a Pediatric ICU Between 2010 and 2016

et al. 2019

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BACKGROUND: In recent years, respiratory support in severe bronchiolitis has changed in several aspects: increased use of noninvasive ventilation, new equipment, and implementation of high-flow nasal cannula therapy. OBJECTIVE: To analyze the effectiveness of the changes progressively introduced in the respiratory support of patients with bronchiolitis to reduce the intubation rate. METHODS: This was a retrospective, observational, descriptive study. Patients admitted to the pediatric ICU of Hospital Sant Joan de Déu (Barcelona, Spain) with respiratory failure due to bronchiolitis in the 2010-2011 and 2016-2017 periods were included. Exclusion criteria were the following: patients who were previously intubated and tracheostomized and patients > 1 y. Data collected were demographic, clinical, and ventilatory variables, including the type, equipment used, and length of the respiratory support received. RESULTS: A total of 161 subjects were included: 53 in the 2010-2011 period and 108 in the 2016-2017 period. No clinical differences were observed except the incidence of previous apnea, a diagnosis of sepsis, and procalcitonin values on admission that were higher in the first period. High-flow nasal cannula use before pediatric ICU admission was significantly higher in 2016-2017. A significant increase in the use of the total face mask was observed. The need for invasive ventilation decreased from 37.7% to 17.5%. In the multivariate study, use of interfaces other than the total face mask was identified as the only independent predictive factor for noninvasive ventilation failure, with an odds ratio of 2.5, 95% CI 1.04-6.2 (P ‫؍‬ .040). CONCLUSIONS: An important reduction in invasive ventilation was observed. An independent predictive factor for noninvasive ventilation failure was in using an interface other than the total face mask. Implementation of high-flow nasal cannula has not been identified as an independent protective factor for intubation.

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Section: Introductionmentioning

confidence: 99%

Comparison in the Management of Respiratory Failure due to Bronchiolitis in a Pediatric ICU Between 2010 and 2016

et al. 2019

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“…( 3 , 4 ) Higher risk of admission to pediatric ICU (PICU), need for mechanical ventilation (MV), long stay at the hospital, and death are associated with low weight, age under 30 days old, prematurity, congenital heart defect, chronic lung disease, and immunodeficiency. ( 3 , 5 , 6 ) AVB is a seasonal viral disease; the main etiologic agent is respiratory syncytial virus, which is present in more than 50% of the cases. ( 7 - 9 )…”

Section: Introductionmentioning

confidence: 99%

Characteristics and progression of children with acute viral bronchiolitis subjected to mechanical ventilation

Ferlini¹,

Pinheiro²,

Andreolio³

et al. 2016

Revista Brasileira De Terapia Intensiva

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ObjectiveTo analyze the characteristics of children with acute viral bronchiolitis subjected to mechanical ventilation for three consecutive years and to correlate their progression with mechanical ventilation parameters and fluid balance.MethodsLongitudinal study of a series of infants (< one year old) subjected to mechanical ventilation for acute viral bronchitis from January 2012 to September 2014 in the pediatric intensive care unit. The children's clinical records were reviewed, and their anthropometric data, mechanical ventilation parameters, fluid balance, clinical progression, and major complications were recorded.ResultsSixty-six infants (3.0 ± 2.0 months old and with an average weight of 4.7 ± 1.4kg) were included, of whom 62% were boys; a virus was identified in 86%. The average duration of mechanical ventilation was 6.5 ± 2.9 days, and the average length of stay in the pediatric intensive care unit was 9.1 ± 3.5 days; the mortality rate was 1.5% (1/66). The peak inspiratory pressure remained at 30cmH2O during the first four days of mechanical ventilation and then decreased before extubation (25 cmH2O; p < 0.05). Pneumothorax occurred in 10% of the sample and extubation failure in 9%, which was due to upper airway obstruction in half of the cases. The cumulative fluid balance on mechanical ventilation day four was 402 ± 254mL, which corresponds to an increase of 9.0 ± 5.9% in body weight. Thirty-seven patients (56%) exhibited a weight gain of 10% or more, which was not significantly associated with the ventilation parameters on mechanical ventilation day four, extubation failure, duration of mechanical ventilation or length of stay in the pediatric intensive care unit.ConclusionThe rate of mechanical ventilation for acute viral bronchiolitis remains constant, being associated with low mortality, few adverse effects, and positive cumulative fluid balance during the first days. Better fluid control might reduce the duration of mechanical ventilation.

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“…A idade média das crianças incluídas no nosso estudo foi de 1,88±1,25 meses. Estudo realizado na Espanha avaliou 229 pacientes internados em UTI pediátrica por BVA e constatou que a idade foi inversamente proporcional ao tempo necessário de suporte ventilatório e de dias de internação em UTI 18,19,20 . Um estudo realizado nos Estados Unidos apontou que de 1,1 milhão de crianças menores de dois anos internadas por VSR em um período de oito anos, a maior porcentagem das internações ocorreu na faixa etária entre três e seis meses 21 .…”

Section: Discussionunclassified

Ventilação mecânica não invasiva na bronquiolite viral aguda: estudo de coorte retrospectivo

et al. 2017

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Bronquiolitis grave. Cambios epidemiológicos y de soporte respiratorio

Abstract: Most patients admitted to the PICU are less than 3 months old. Mortality was 0.9%. Respiratory support (especially non-invasive mechanical ventilation and high flow nasal oxygen therapy) is used increasingly often. The youngest patients need more days in PICU and more respiratory support.

Cited by 20 publications

References 23 publications

Comparison in the Management of Respiratory Failure due to Bronchiolitis in a Pediatric ICU Between 2010 and 2016

Comparison in the Management of Respiratory Failure due to Bronchiolitis in a Pediatric ICU Between 2010 and 2016

Characteristics and progression of children with acute viral bronchiolitis subjected to mechanical ventilation

Ventilação mecânica não invasiva na bronquiolite viral aguda: estudo de coorte retrospectivo

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