Suctioning and Length of Stay in Infants Hospitalized With Bronchiolitis

Abstract

Importance: Hospitalizations of infants for bronchiolitis are common and costly. Despite the high incidence and resource burden of bronchiolitis, the mainstay of treatment remains supportive care, which frequently includes nasal suctioning. Objective: To examine the association between suctioning device type and suctioning lapses greater than 4 hours within the first 24 hours after hospital admission on length of stay (LOS) in infants with bronchiolitis. Design: Retrospective cohort study. Data were extracted from the electronic health record. Setting: Main hospital and satellite facility of a large quaternary care children’s hospital from January 10, 2010, through April 30, 2011. Participants: A total of 740 infants aged 2 to 12 months and hospitalized with bronchiolitis. Main Outcome Measure: Hospital LOS. Results: In the multivariable model adjusted for inverse weighting for propensity to receive deep suctioning, increased deep suction as a percentage of suction events was associated with increased LOS with a geometric mean of 1.75 days (95% CI, 1.56–1.95 days) in patients with no deep suction and 2.35 days (2.10–2.62 days) in patients with more than 60% deep suction. An increased number of suctioning lapses was also associated with increased LOS in a dose-dependent manner with a geometric mean of 1.62 days (95% CI, 1.43–1.83 days) in patients with no lapses and 2.64 days (2.30–3.04 days) in patients with 3 or 4 lapses. Conclusions and Relevance: For patients admitted with bronchiolitis, the use of deep suctioning in the first 24 hours after admission and lapses greater than 4 hours between suctioning events were associated with longer LOS.

Audit on the Management of Bronchiolitis: A Single Centre Real World Experience in Bangladesh Can We do Better ?

“…The difference of the length of hospital stay between two groups was not statistically significant (p value .06), which correlated with other studies 19,20 .…”

Using Quality Improvement to Reduce Continuous Pulse Oximetry Use in Children With Wheezing

“…Although multiple studies have demonstrated that oxygen saturation influences admission rates, 31,32 other factors such as poor oral intake and need for aggressive suctioning may be important drivers of LOS. Studies have described an association between decreased oral intake and nasal suctioning with LOS in infants with bronchiolitis, [33][34][35] and our interventions did not have any impact on suctioning practices or improving oral intake for patients. The median time to medically ready in our study was also ,25 hours on our intervention unit; it is possible that reducing LOS further may be challenging.…”

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

“…Although suctioning the nares may provide temporary relief of nasal congestion or upper airway obstruction, a retrospective study reported that deep suctioning 150 was associated with longer LOS in hospitalized infants 2 to 12 months of age. The same study also noted that lapses of greater than 4 hours in noninvasive, external nasal suctioning were also associated with longer LOS.…”