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Treatment of severe bronchiolitis: A survey of Canadian pediatric intensivists
Author(s) -
Bradshaw Matthew L.,
Déragon Alexandre,
Puligandla Pramod,
Emeriaud Guillaume,
Canakis AnneMarie,
Fontela Patricia S.
Publication year - 2018
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23974
Subject(s) - medicine , bronchiolitis , nasal cannula , logistic regression , intensive care , emergency medicine , pediatric intensive care unit , intensive care medicine , pediatrics , cannula , respiratory system , surgery
Objective To describe management practices and the factors guiding admission and treatment decisions for viral bronchiolitis across Canadian pediatric intensive care units (PICUs). Design Cross‐sectional survey. Setting Canadian PICUs. Subjects Pediatric intensivists. Measurements and Main Results A survey using two case scenarios (non‐intubated vs intubated patients) was developed using focus groups and a literature review. We analyzed our results using descriptive statistics and multivariate logistic regression. Our response rate was 55% (57/103). Regarding bronchiolitis management, 75% (42/56) of respondents would use inhaled therapies, with nebulized epinephrine (33/56, 59%) and salbutamol (20/56, 36%) being the most common. Antibiotic use within the first hour of admission to PICU almost doubled in frequency (36% vs 71%) in patients who required mechanical ventilation (p 0.0004). High flow nasal cannula (HFNC; 32/56, 57%) and continuous positive airway pressure (CPAP; 16/56, 29%) were the preferred modes of non‐invasive ventilation (NIV). Conclusion The management of severe viral bronchiolitis is similar across Canadian PICUs. The use of NIV, inhaled treatments, and antibiotics is frequent, which differs from the recommendations made by published guidelines. Canadian pediatric intensivists use homogeneous PICU admission criteria based on patients’ characteristics and severity of the clinical picture. Clinical practice guidelines for children with viral bronchiolitis should address the management of patients with severe clinical disease.