Risk Factors for Respiratory Decompensation Among Healthy Infants With Bronchiolitis

Dadlez, Nina M.; Esteban-Cruciani, Nora; Khan, Asama; Douglas, Lindsey C.; Shi, Yi; Southern, William N.

doi:10.1542/hpeds.2017-0034

Cited by 18 publications

(25 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1, 7 -13 Previous studies of severe bronchiolitis 9, 14 -20 have been focused on hospitalization, which encompasses a broad range of disease severity and the inpatient population, rather than infants presenting to the emergency department (ED). [21][22][23] Studies of infants managed in ICUs have not included patients treated with highflow nasal cannula (HFNC), 16, 24 -29 which is an increasingly used respiratory support in severe bronchiolitis. 30,31 Receipt of airway support, including HFNC, is a critical outcome for bronchiolitis, offering a more objective measure of disease severity compared with hospitalization.…”

mentioning

confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES:Early risk stratification of infants with bronchiolitis receiving airway support is critical for focusing appropriate therapies, yet the tools to risk categorize this subpopulation do not exist. Our objective was to identify predictors of "escalated care" in bronchiolitis. We hypothesized there would be a significant association between escalated care and predictors in the emergency department. We subsequently developed a risk score for escalated care. METHODS:We conducted a retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was escalated care (ie, hospitalization with high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care admission). The predictors evaluated were age, prematurity, day of illness, poor feeding, dehydration, apnea, nasal flaring and/or grunting, respiratory rate, oxygen saturation, and retractions. . One of 217 (0.5%) infants without predictors received escalated care. The risk score ranged from 0 to 14 points, with the estimated risk of escalated care from 0.46% (0 points) to 96.9% (14 points). The area under the curve was 85%. CONCLUSIONS:We identified variables measured in the emergency department predictive of escalated care in bronchiolitis and derived a risk score to stratify risk of this outcome. This score may be used to aid management and disposition decisions.

show abstract

mentioning

confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Every year, it causes over 300 000 ED visits in the USA and over 3.4 million hospitalizations worldwide . Although the majority of children with bronchiolitis have a self‐limited mild or moderate illness, some of them may present with severe respiratory distress and require respiratory support . Numerous medications have been frequently used to manage acute bronchiolitis (eg, oxygen, hydration, bronchodilators, corticosteroids, antibiotics, antivirals, nasal decongestants, immunoglobulins), but only oxygen and hydration have been shown to demonstrably improve the condition of infants with bronchiolitis .…”

Section: Introductionmentioning

confidence: 99%

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

Yurtseven

Turan

Erseven

et al. 2019

Pediatric Pulmonology

View full text Add to dashboard Cite

Objective We aimed to compare the heated humidiﬁed high‐ﬂow nasal cannula (HHHFNC) flow rate of 1‐L·kg·min−1 (1 L) with 2‐L·kg·min −1 (2 L) in patients with severe bronchiolitis presenting to the pediatric emergency department. Study design We performed a study in which all patients were allocated to receive these two flow rates. The primary outcome was admitted as treatment failure, which was defined as a clinical escalation in respiratory status. Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), the clinical respiratory score (CRS), rise of peripheral capillary oxygen saturation (SpO2), and rates of weaning, intubation, and intensive care unit (ICU) admission. Results One hundred and sixty‐eight cases (88 received the 1‐L flow rate and 80, the 2‐L flow rate) were included in the analyses. Treatment failure was 11.4% (10 of 88) in the 1‐L group, and 10% (8 of 80) in the 2‐L group (P = .775). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, the rate of weaning (53.4% vs 35%; P = .017), the falling down of the CRS (−2.1 vs −1.5; P < .001), RR (−15.2 vs −11.8; P < .001), and HR (− 24.8 vs − 21.2; P < .001), and the increase of SpO 2 (4.8 vs 3.6; P < .001) were significantly more evident in the 1‐L group. Conclusion HHHFNC with the 1‐L·kg·min−1 flow rate, which provides a more frequent earlier effect, reached therapy success as high as the 2‐L·kg·min −1 flow rate in patients with severe acute bronchiolitis.

show abstract

“…There was a slight male predominance in our study (57% male, 43% female), which is consistent with previous studies. 11,15 The median age of those with severe (2.7) and nonsevere infection (1.7) is higher in this study due to the inclusion of a wider age range compared with other studies that tended to focus on children aged 2 years and under, the typical age range for symptomatic RSV bronchiolitis. 3,16 Hypoxia was significantly higher in the severe group (64.7%) compared with the nonsevere group (32%).…”

Section: Discussionmentioning

confidence: 83%

“…There was a slight male predominance in our study (57% male, 43% female), which is consistent with previous studies. 11,15…”

Section: Discussionmentioning

confidence: 99%

Retrospective Review of Clinical and Chest X-Ray Findings in Children Admitted to a Community Hospital for Respiratory Syncytial Virus Infection

Niles

Larsen

Arvind

et al. 2018

Clin Pediatr (Phila)

View full text Add to dashboard Cite

show abstract

Risk Factors for Respiratory Decompensation Among Healthy Infants With Bronchiolitis

Cited by 18 publications

References 21 publications

Predicting Escalated Care in Infants With Bronchiolitis

Predicting Escalated Care in Infants With Bronchiolitis

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

Retrospective Review of Clinical and Chest X-Ray Findings in Children Admitted to a Community Hospital for Respiratory Syncytial Virus Infection

Contact Info

Product

Resources

About

Risk Factors for Respiratory Decompensation Among Healthy Infants With Bronchiolitis

Cited by 18 publications

References 21 publications

Predicting Escalated Care in Infants With Bronchiolitis

Predicting Escalated Care in Infants With Bronchiolitis

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min−1 vs 2‐L·kg·min−1) in the management of acute bronchiolitis

Retrospective Review of Clinical and Chest X-Ray Findings in Children Admitted to a Community Hospital for Respiratory Syncytial Virus Infection

Contact Info

Product

Resources

About

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis