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. 2023 Jan;49(1):5-25.
doi: 10.1007/s00134-022-06918-4. Epub 2023 Jan 2.

Clinical practice guidelines: management of severe bronchiolitis in infants under 12 months old admitted to a pediatric critical care unit

Christophe Milési  1 , Florent Baudin  2 , Philippe Durand  3 , Guillaume Emeriaud  4 , Sandrine Essouri  5 , Robin Pouyau  2 , Julien Baleine  6 , Sophie Beldjilali  7 , Alice Bordessoule  8 , Sophie Breinig  9 , Pierre Demaret  10 , Philippe Desprez  11 , Bénédicte Gaillard-Leroux  12 , Julie Guichoux  13 , Anne-Sophie Guilbert  14 , Camille Guillot  15 , Sandrine Jean  16 , Michael Levy  17 , Odile Noizet-Yverneau  18 , Jérôme Rambaud  16 , Morgan Recher  15 , Stéphanie Reynaud  2 , Fréderic Valla  2 , Karim Radoui  19 , Marie-Agnes Faure  20 , Guillaume Ferraro  21 , Guillaume Mortamet  22 ; French Speaking Group for Pediatric Intensive and Emergency Care
Affiliations

Clinical practice guidelines: management of severe bronchiolitis in infants under 12 months old admitted to a pediatric critical care unit

Christophe Milési et al. Intensive Care Med. 2023 Jan.

Abstract

Purpose: We present guidelines for the management of infants under 12 months of age with severe bronchiolitis with the aim of creating a series of pragmatic recommendations for a patient subgroup that is poorly individualized in national and international guidelines.

Methods: Twenty-five French-speaking experts, all members of the Groupe Francophone de Réanimation et Urgence Pédiatriques (French-speaking group of paediatric intensive and emergency care; GFRUP) (Algeria, Belgium, Canada, France, Switzerland), collaborated from 2021 to 2022 through teleconferences and face-to-face meetings. The guidelines cover five areas: (1) criteria for admission to a pediatric critical care unit, (2) environment and monitoring, (3) feeding and hydration, (4) ventilatory support and (5) adjuvant therapies. The questions were written in the Patient-Intervention-Comparison-Outcome (PICO) format. An extensive Anglophone and Francophone literature search indexed in the MEDLINE database via PubMed, Web of Science, Cochrane and Embase was performed using pre-established keywords. The texts were analyzed and classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. When this method did not apply, an expert opinion was given. Each of these recommendations was voted on by all the experts according to the Delphi methodology.

Results: This group proposes 40 recommendations. The GRADE methodology could be applied for 17 of them (3 strong, 14 conditional) and an expert opinion was given for the remaining 23. All received strong approval during the first round of voting.

Conclusion: These guidelines cover the different aspects in the management of severe bronchiolitis in infants admitted to pediatric critical care units. Compared to the different ways to manage patients with severe bronchiolitis described in the literature, our original work proposes an overall less invasive approach in terms of monitoring and treatment.

Keywords: Bronchiolitis; Guidelines; High-flow nasal cannula; Noninvasive ventilation; Pediatric intensive care; Recommendation.

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