Trends in Bronchiolitis ICU Admissions and Ventilation Practices: 2010-2019

Abstract

Objectives: To determine the changes in ICU admissions, ventilatory support, length of stay, and cost for patients with bronchiolitis in the United States.

Methods: Retrospective cross-sectional study of the Pediatric Health Information Systems database. All patients age <2 years admitted with bronchiolitis and discharged between January 1, 2010 and December 31, 2019, were included. Outcomes included proportions of annual ICU admissions, invasive mechanical ventilation (IMV), noninvasive ventilation (NIV), and cost.

Results: Of 203 859 admissions for bronchiolitis, 39 442 (19.3%) were admitted to an ICU, 6751 (3.3%) received IMV, and 9983 (4.9%) received NIV. ICU admissions for bronchiolitis doubled from 11.7% in 2010 to 24.5% in 2019 (P < .001 for trend), whereas ICU admissions for all children in Pediatric Health Information Systems <2 years of age increased from 16.0% to 21.1% during the same period (P < .001 for trend). Use of NIV increased sevenfold from 1.2% in 2010 to 9.5% in 2019 (P < .001 for trend). Use of IMV did not significantly change (3.3% in 2010 to 2.8% in 2019, P = .414 for trend). In mixed-effects multivariable logistic regression, discharge year was a significant predictor of NIV (odds ratio: 1.24; 95% confidence interval [CI]: 1.23-1.24) and ICU admission (odds ratio: 1.09; 95% CI: 1.09-1.09) but not IMV (odds ratio: 1.00; 95% CI: 1.00-1.00).

Conclusions: The proportions of children with bronchiolitis admitted to an ICU and receiving NIV have substantially increased, whereas the proportion receiving IMV is unchanged over the past decade. Further study is needed to better understand the factors underlying these temporal patterns.

FIGURE 1

Incidence of bronchiolitis and cost of care over time. A, the total number of inpatient admissions for the included hospitals on the left axis, including patients with a primary diagnosis of bronchiolitis (dark gray), and those without (light gray). The black line shows the percentage of admissions with bronchiolitis on the right y-axis. B, identical to (A) except that patients with any encounter diagnosis of bronchiolitis are included. C, the total annual cost of admissions, adjusted for the Center for Medicare & Medicaid services wage/price index for the hospital zip code, and the annual GDP and expressed in 2010 dollars. The color scale shows patients receiving both invasive and non-invasive ventilation (dark gray), invasive ventilation (medium gray), non-invasive ventilation (medium gray #2), and no ventilatory support (light gray). D, identical to (C) except that except that patients with any encounter diagnosis of bronchiolitis are included (as in B).

FIGURE 2

The percentage of patients with bronchiolitis (A) and all hospital admissions <2 years of age (B) admitted to the ICU over time. The y-axis shows the percent of admissions admitted to the ICU, and the x-axis shows patients grouped by discharge year. Numbers within the bars represent the percentage.

FIGURE 3

Changes in ventilatory support over time. A, the percentage of patients with bronchiolitis receiving noninvasive (light gray) and invasive (dark gray) ventilatory support. The y-axis represents percent of admissions, and the x-axis shows patients grouped by discharge year. Numbers within the bars represent the percentage. B, absolute numbers of invasive (dark gray), noninvasive (medium gray), and no (light gray) ventilatory support among patients admitted to the ICU. The y-axis shows absolute numbers, and the x-axis shows patients grouped by discharge year.