Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis

Serra, Jesús Alberto; González‐Dambrauskas, Sebastián; Vásquez‐Hoyos, Pablo; Carvajal, C; Donoso, Alejandro; Cruces, Pablo; Fernández, Alicia Ruth; Arroyo, Luis Martínez; Sarmiento, María Piedad; Núñez, Marı́a José; Araya, Adriana Wegner; Jaramillo-Bustamante, Juan Camilo; Céspedes-Lesczinsky, M.; Jabornisky, Roberto; Monteverde-Fernández, Nicolas; Cordova, Tamara; Díaz, Franco

doi:10.32641/rchped.v91i2.1156

Cited by 9 publications

(9 citation statements)

References 34 publications

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“…The intubation rate in our study is higher than in previous studies [4,[22][23][24], while our re-intubation rate is comparable to previously reported re-intubation rates [25,26]. A largescale observational study in Australia reported a 37% intubation rate in children admitted to the PICU in 2002 [4].…”

Section: Discussionsupporting

confidence: 70%

Burden of respiratory syncytial virus bronchiolitis on the Dutch pediatric intensive care units

et al. 2021

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Respiratory syncytial virus (RSV) bronchiolitis causes substantial morbidity and mortality in young children, but insight into the burden of RSV bronchiolitis on pediatric intensive care units (PICUs) is limited. We aimed to determine the burden of RSV bronchiolitis on the PICUs in the Netherlands. Therefore, we identified all children ≤ 24 months of age with RSV bronchiolitis between 2003 and 2016 from a nationwide PICU registry. Subsequently we manually checked their patient records for correct diagnosis and collected patient characteristics, additional clinical data, respiratory support modes, and outcome. In total, 2161 children were admitted to the PICU for RSV bronchiolitis. The annual number of admissions increased significantly during the study period (β 4.05, SE 1.27, p = 0.01), and this increase was mostly driven by increased admissions in children up to 3 months old. Concomitantly, non-invasive respiratory support significantly increased (β 7.71, SE 0.92, p < 0.01), in particular the use of high flow nasal cannula (HFNC) (β 6.69, SE 0.96, p < 0.01), whereas the use of invasive ventilation remained stable.Conclusion: The burden of severe RSV bronchiolitis on PICUs has increased in the Netherlands. Concomitantly, the use of non-invasive respiratory support, especially HFNC, has increased. What is Known:• RSV bronchiolitis is a major cause of childhood morbidity and mortality and may require pediatric intensive care unit admission.• The field of pediatric critical care for severe bronchiolitis has changed due to increased non-invasive respiratory support options. What is New:• The burden of RSV bronchiolitis for the Dutch PICUs has increased. These data inform future strategic PICU resource planning and implementation of RSV preventive strategies.• There was a significant increase in the use of high flow nasal cannula at the PICU, but the use of invasive mechanical ventilation did not decrease.

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Section: Discussionsupporting

confidence: 70%

Burden of respiratory syncytial virus bronchiolitis on the Dutch pediatric intensive care units

et al. 2021

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“…Fifth, our score is most applicable at institutions similar to these 128 centers. Although our demographics, MV usage, and outcomes are similar to cohorts from around the globe (1,25,(30)(31)(32), generalizability to ICUs with more ill patient populations, unique practices, or distinctive ICU admission criteria may be limited. In addition, applicability at institutions where HFNC is used on the wards may vary.…”

Section: Discussionmentioning

confidence: 92%

Derivation and Validation of the Critical Bronchiolitis Score for the PICU

Mount

Kattan

et al. 2021

Pediatric Critical Care Medicine

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To derive and internally validate a bronchiolitis-specific illness severity score (the Critical Bronchiolitis Score) that out-performs mortality-based illness severity scores (e.g., Pediatric Risk of Mortality) in measuring expected duration of respiratory support and PICU length of stay for critically ill children with bronchiolitis.DESIGN: Retrospective database study using the Virtual Pediatric Systems (VPS, LLC; Los Angeles, CA) database. SETTING:One-hundred twenty-eight North-American PICUs.PATIENTS: Fourteen-thousand four-hundred seven children less than 2 years old admitted to a contributing PICU with primary diagnosis of bronchiolitis and use of ICU-level respiratory support (defined as high-flow nasal cannula, noninvasive ventilation, invasive mechanical ventilation, or negative pressure ventilation) at 12 hours after PICU admission. INTERVENTIONS:Patient-level variables available at 12 hours from PICU admission, duration of ICU-level respiratory support, and PICU length of stay data were extracted for analysis. After randomly dividing the cohort into derivation and validation groups, patient-level variables that were significantly associated with the study outcomes were selected in a stepwise backward fashion for inclusion in the final score. Score performance in the validation cohort was assessed using root mean squared error and mean absolute error, and performance was compared with that of existing PICU illness severity scores. MEASUREMENTS AND MAIN RESULTS:Twelve commonly available patientlevel variables were included in the Critical Bronchiolitis Score. Outcomes calculated with the score were similar to actual outcomes in the validation cohort. The Critical Bronchiolitis Score demonstrated a statistically significantly stronger association with duration of ICU-level respiratory support and PICU length of stay than mortality-based scores as measured by root mean squared error and mean absolute error. CONCLUSIONS:The Critical Bronchiolitis Score performed better than PICU mortality-based scores in measuring expected duration of ICU-level respiratory support and ICU length of stay. This score may have utility to enrich interventional trials and adjust for illness severity in observational studies in this very common PICU condition.

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“…Another factor in the low infection rate among pediatric healthcare workers is the usual seasonal epidemic of viral respiratory infections. Every winter, we face a sudden increase in up to 400% of children with acute respiratory failure due to respiratory viruses [ 33 ]. Our greatest strengths are the interventions aimed at preventing respiratory failure progression, balancing the risks of overtreatment and futile treatments, and delaying lifesaving therapies, like MV.…”

Section: Discussionmentioning

confidence: 99%

Clinical and organizational framework of repurposing pediatric intensive care unit to adult critical care in a resource-limited setting: Lessons from the response of an urban general hospital to the COVID-19 pandemic

Díaz¹,

Kehr²,

Cores³

et al. 2022

Journal of Critical Care

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Purpose We aim to describe the action plan and clinical results of a COVID-19 unit for adult patient care in units intended for critically ill children, proposing a clinical/administrative framework. Methods We reviewed the preparedness of the PICU team before the surge of cases of COVID-19 and the organizational/administrative issues to increase critical beds in a six-bed PICU allocated to adult critical care in a government-funded general hospital in Latin America. We analyzed the prospectively collected administrative/clinical data of severe COVID-19 cases admitted to PICU during the peak of the first wave of the pandemic. Results We describe a 6-step preparedness plan: recruitment and education, admission criteria, children diversion, team hierarchy, and general and respiratory equipment. The 6-bed PICU was allocated to adult care for 20 weeks, progressively increasing capacity to a 23-bed dedicated COVID-19 unit managed by the PICU team. A six-block bed organizational units were implemented, and personnel increased from 40 to 125 healthcare workers in 24 h shifts. COVID-19 incidence in personnel was 0.5/1000 workdays. One hundred thirty-six patients were admitted, median age 59 (51,65) years old, 68% were male, and 63% had P/F ≤ 100. In addition, 48% received mechanical ventilation, the median length of stay was 7 (3,17), and in-hospital mortality was 15%. Conclusions We propose an organizational framework for the role of PICU in the hospital action plan to increase adult critical beds. The cohort of patients admitted to a PICU repurposed as a COVID-19 ICU had good outcomes. These data are valuable to plan coordinated actions of the healthcare system for future scenarios.

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Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis

Cited by 9 publications

References 34 publications

Burden of respiratory syncytial virus bronchiolitis on the Dutch pediatric intensive care units

Burden of respiratory syncytial virus bronchiolitis on the Dutch pediatric intensive care units

Derivation and Validation of the Critical Bronchiolitis Score for the PICU

Clinical and organizational framework of repurposing pediatric intensive care unit to adult critical care in a resource-limited setting: Lessons from the response of an urban general hospital to the COVID-19 pandemic

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