Non-invasive ventilation for severe bronchiolitis: Analysis and evidence
Objectives (1) To examine whether infants with severe bronchiolitis, fulfilling criteria for further respiratory support, could be managed outside a Pediatric Intensive Care Unit (PICU) with non‐invasive ventilation (NIV) alone. (2) To study the characteristics, clinical course and outcome of NIV re...
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Published in | Pediatric pulmonology Vol. 47; no. 9; pp. 909 - 916 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
Hoboken
Wiley Subscription Services, Inc., A Wiley Company
01.09.2012
Wiley-Liss |
Subjects | |
Online Access | Get full text |
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Summary: | Objectives
(1) To examine whether infants with severe bronchiolitis, fulfilling criteria for further respiratory support, could be managed outside a Pediatric Intensive Care Unit (PICU) with non‐invasive ventilation (NIV) alone. (2) To study the characteristics, clinical course and outcome of NIV responders and non responders to assess safety and efficacy and inform guideline construction.
Hypothesis
Infants with severe bronchiolitis can be safely managed with NIV outside a PICU.
Study Design
Retrospective case review.
Patient Selection
Cohort of infants with objective evidence of severe bronchiolitis requiring respiratory support nursed in a Pediatric High Dependency Unit (PHDU) and/or Intensive Care Unit (ICU) between 2001 and 2007.
Methodology
Analysis of patient characteristics and respiratory parameters at admission and initiation of ventilation, changes after 2 and 4 hr of NIV or invasive ventilation, complications, short and long‐term outcomes were analyzed.
Results
One thousand and thirty‐five infants with bronchiolitis were admitted with 67 ventilation episodes identified from 65 patients. Fifty‐five episodes, including 34 with apnea, were treated exclusively with NIV. Six infants failed to respond and were invasively ventilated. Six patients were invasively ventilated at presentation. Non‐responders had a significantly higher rate of bacterial infection. Significant improvements in respiratory parameters in responders occurred by 2 hr and sustained at 4 hr. Duration of hospital stay, ventilation requirement and oxygen requirement were significantly shorter in responders. Short and longer‐term follow up data did not identify any adverse effects related to NIV.
Conclusions
NIV was effective in 80% of infants receiving respiratory support for severe bronchiolitis. Pediatr Pulmonol. 2012. 47:909–916. © 2012 Wiley Periodicals, Inc. |
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Bibliography: | none reported istex:3BA7FD418C12CF7AFAB7D0ED1B0F87D46B15900D ark:/67375/WNG-Q7FX7VNR-V ArticleID:PPUL22513 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 8755-6863 1099-0496 |
DOI: | 10.1002/ppul.22513 |