Comparison in the Management of Respiratory Failure due to Bronchiolitis in a Pediatric ICU Between 2010 and 2016

Abstract

Background: In recent years, respiratory support in severe bronchiolitis has changed in several aspects: increased use of noninvasive ventilation, new equipment, and implementation of high-flow nasal cannula therapy.

Objective: To analyze the effectiveness of the changes progressively introduced in the respiratory support of patients with bronchiolitis to reduce the intubation rate.

Methods: This was a retrospective, observational, descriptive study. Patients admitted to the pediatric ICU of Hospital Sant Joan de Déu (Barcelona, Spain) with respiratory failure due to bronchiolitis in the 2010-2011 and 2016-2017 periods were included. Exclusion criteria were the following: patients who were previously intubated and tracheostomized and patients > 1 y. Data collected were demographic, clinical, and ventilatory variables, including the type, equipment used, and length of the respiratory support received.

Results: A total of 161 subjects were included: 53 in the 2010-2011 period and 108 in the 2016-2017 period. No clinical differences were observed except the incidence of previous apnea, a diagnosis of sepsis, and procalcitonin values on admission that were higher in the first period. High-flow nasal cannula use before pediatric ICU admission was significantly higher in 2016-2017. A significant increase in the use of the total face mask was observed. The need for invasive ventilation decreased from 37.7% to 17.5%. In the multivariate study, use of interfaces other than the total face mask was identified as the only independent predictive factor for noninvasive ventilation failure, with an odds ratio of 2.5, 95% CI 1.04-6.2 (P = .040).

Conclusions: An important reduction in invasive ventilation was observed. An independent predictive factor for noninvasive ventilation failure was in using an interface other than the total face mask. Implementation of high-flow nasal cannula has not been identified as an independent protective factor for intubation.

Keywords: acute respiratory failure; bronchiolitis; high-flow nasal cannula; pediatric; pediatric ICU; total face mask.