Temporal Changes in Prescription of Neuropharmacologic Drugs and Utilization of Resources Related to Neurologic Morbidity in Mechanically Ventilated Children With Bronchiolitis

• Published in: Pediatric critical care medicine Vol. 18; no. 12; p. e606
• Main Authors: Shein, Steven L, Slain, Katherine, Wilson-Costello, Deanne, McKee, Bryan, Rotta, Alexandre T
• Format: Journal Article
• Language: English
• Published: United States 01.12.2017
• Subjects: Analgesics - therapeutic use; Bronchiolitis - complications; Bronchiolitis - therapy; Child, Preschool; Combined Modality Therapy; Databases, Factual; Drug Utilization - statistics & numerical data; Drug Utilization - trends; Female; Hospitals, Pediatric; Humans; Hypnotics and Sedatives - therapeutic use; Infant; Infant, Newborn; Male; Nervous System Diseases - diagnosis; Nervous System Diseases - drug therapy; Nervous System Diseases - etiology; Nervous System Diseases - rehabilitation; Neuroimaging - statistics & numerical data; Neuroimaging - trends; Neuropsychological Tests; Occupational Therapy - statistics & numerical data; Occupational Therapy - trends; Physical Therapy Modalities - statistics & numerical data; Physical Therapy Modalities - trends; Practice Patterns, Physicians' - statistics & numerical data; Practice Patterns, Physicians' - trends; Respiration, Artificial; Retrospective Studies; United States
• ISSN: 1529-7535
• DOI: 10.1097/PCC.0000000000001351

Critically ill children with bronchiolitis may require neuropharmacologic medications and support for neuro-functional sequelae, but current practices are not well described. We aimed to describe recent trends in neuropharmacology and utilization of neuro-rehabilitation resources in mechanically ventilated children with bronchiolitis. Analysis of the multicenter Pediatric Health Information System database. Forty-seven U.S. children's hospitals. PICU patients less than 2 years old with bronchiolitis undergoing mechanical ventilation between 2006 and 2015. None. Annual rates of utilization of neuropharmacologic medications (sedatives, analgesics, etc) and of neuro-rehabilitation services (physical therapy, neurologic consultation, etc) over the 10-year study period were compared. Neuropharmacologic medications prescribed on greater than or equal to 2 days were extracted. Utilization of MRI of the brain, neurologic consultation, swallow evaluation, occupational therapy, and physical therapy was also extracted. Among 12,508 subjects, the median age was 2.8 months, ~50% had comorbid conditions, and the median duration of mechanical ventilation was 7 days. The percentage of children prescribed greater than or equal to five drugs/drug classes increased over the study period from 36.5% to 55.8% (p < 0.001). There were significant increases over time in utilization of 10 of the 15 individual drugs/drug classes analyzed. More than half of subjects (6,294 [50.3%]) received at least one service that evaluates/treats neurologic morbidity. There were significant increases in the use of greater than or equal to one service (36.3% in 2006 to 59.6% in 2015; p < 0.001) and in the use of greater than or equal to two services (20.8% to 34.8%; p < 0.001). Utilization of each of the five individual resources increased significantly during the study period, but use of vasoactive medications and mortality did not. Prescription of neuropharmacologic agents increased over time using metrics of both overall drug burden and specific drug usage. Concurrently, the utilization of services that evaluate and/or treat neurologic morbidity was common and also increased over time.