Bronchiolitis admissions in 13 pediatric intensive care units in Uruguay
Is it the same in Montevideo (capital city) and the provinces?
DOI:
https://doi.org/10.29193/RMU.37.2.6Keywords:
BRONCHIOLITIS, NONINVASIVE VENTILATION, HIGH FLOW NASAL CANNULA, MORBIDITY, PEDIATRIC INTENSIVE CARE UNITS, CHILDAbstract
Objectives: to describe the clinical and epidemiological characteristics of children admitted for bronchiolitis in 13 Pediatric Intensive Care Units (UCIP) in Uruguay and compare the final care outcomes between Montevideo (UM) and Interior of the country (IU).
Method: multicenter, retrospective, observational study of data entered in the LARed Network prospective database. Children over 1 month and younger than 2 years admitted between May 1, 2017 and April 30, 2019 with a diagnosis of Community Bronchiolitis were included in the study. Demographic and clinical data were analyzed, as well as interventions and discharge outcomes.
Results: 666 cases were analyzed. No significant differences in comorbidity and respiratory support were detected at admission. In IU patients were referred more frequently from another hospital. The distance and average time, as well as the percentage of transfers greater than 50 km, was also higher. In IU, patients had greater clinical and gasometrical severity at admission. The radiological and etiological profile was similar (VRS at > 50%). The overall indication of corticosteroids exceeded 25% and that of bronchodilators exceeded 85%. The prescription for antibiotics and nebulized adrenaline was higher in IU. The high flow nasal cannula (HFNC) was globally the most widely used respiratory support method, although increased use of invasive mechanical ventilation (IMV) and CPAP in IU (43% vs 28% in UM) was observed. There were no differences in the number of complications from IVF or non-invasive ventilation, nor in the use of rescue therapies. There were also no significant differences in the length of stay at UCIP or in absolute and adjusted mortality and there was only one case of new morbidity.
Conclusions: children admitted to IU had higher severity scores and more transfer-related risk factors, received more antibiotics and invasive support. HFNC was the most widely used type of respiratory support in the country. A high prescription of non-recommended therapies such as bronchodilators and corticosteroids was detected. Mortality and complications were low, as were the generation of new morbidity.
References
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19) Morosini F, Notejane M, Machado K, Paéz M, Rompani E, Taboada R, et al. Ventilación no invasiva y oxigenoterapia de alto flujo en salas de cuidados moderados. Experiencia en la Unidad de Cuidados Especiales Respiratorios Agudos del Hospital Pediátrico del CHPR durante 2013-2016. Arch Pediatr Urug 2018; 89(2):78-85.
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21) Ramos-Fernández JM, Pedrero-Segura E, Gutiérrez-Bedmar M, Delgado-Martín B, Cordón-Martínez AM, Moreno-Pérez D, et al. Epidemiología de los ingresos por bronquiolitis en el sur de Europa: análisis de las epidemias 2010-2015. An Pediatr (Barc) 2017; 87(5):260-8.
22) Flores-González J, Valladares CM, Yun-Castilla C, Mayordomo-Colunga J, Quesada SP, Martín Delgado CM, et al. Association of fluid overload in critically ill children with bronchiolitis: bronquiolitis en la Unidad de Cuidados Intensivos Pediátricos (BRUCIP) Study. Pediatr Crit Care Med 2019; 20(3):e130-6.
23) Jacobs A, Flechet M, Vanhorebeek I, Verstraete S, Ingels C, Casaer MP, et al. Performance of pediatric mortality prediction scores for PICU mortality and 90-days mortality. Pediatr Crit Care Med 2019; 20(2):113-9.
24) Giachetto G, Vomero A, Pandolfo S, Notejane M, García L, Cavallieri F, et al. Validación del score clínico de Tal modificado para la evaluación de severidad en bronquiolitis. Arch Pediatr Urug 2018; 89(Suppl. 1):43-8.
25) Pérez W, Giachetto G, García L, Vomero A, Pandolfo S, Cavallieri F, et al. Opinión de expertos sobre el artículo “Validación del score clínico de Tal modificado para la evaluación de severidad en bronquiolitis”. Arch Pediatr Urug 2019; 90(3):89-94.
26) Duarte-Dorado DM, Madero-Orostegui DS, Rodriguez-Martinez CE, Nino G. Validation of a scale to assess the severity of bronchiolitis in a population of hospitalized infants. J Asthma 2013; 50(10):1056-61. doi: 10.3109/02770903.2013.834504.
27) Serra JA, González-Dambrauskas S, Vásquez Hoyos P, Carvajal C, Donoso A, Cruces P, et al. Variabilidad terapéutica en lactantes con bronquiolitis hospitalizados en unidades de cuidados intensivos latinoamericanas. Rev Chil Pediatr 2020; 91(2):216-25. doi:10.32641/rchped.v91i2.1156.
28) Pilar Orive FJ, López Fernández Y; UCIP. Hospital de Cruces. Guía para el manejo de la bronquiolitis aguda. Sociedad y Fundación Española de Cuidados Intensivos Pediátricos, 2013. Disponible en: http://secip.com/wp-content/uploads/2018/06/Protocolo-Bronquiolitis-2013.pdf [Consulta: 6 junio 2019].
29) Oakley E, Brys T, Borland M, Neutze J, Philipps N, Krieser D, et al. Medication use in infants admitted with bronchiolitis. Emerg Med Australas 2018; 30(3):389-97.
30) National Institute for Health and Care Excellence. Bronchiolitis in children: diagnosis and management. June 2015. Disponible en: http:/www.nice.org.uk/guidance/ng9 [Consulta: junio 2016].
31) Stobbelaar K, Kool M, de Kruijf D, Van Hoorenbeck K, Jorens P, De Doooy J, et al. Nebulised hypertonic saline in children with bronchiolitis admitted to the paediatric intensive care unit: a retrospective study. J Paediatr Child Health 2019; 55(9):1125-32. doi: 10.1111/jpc.1437.
32) Shein SL, Kong M, McKee E, O´Riordan MA, Toltzis P, Randolph AG. Antibiotic prescription in young children with respiratory syncytial virus-associated respiratory failure and associated outcomes. Pediatr Crit Care Med 2019; 20(2):101-9.
33) Morris JV, Kapetanstrataki M, Parslow RC, Davis PJ, Ramnarayan P. Patterns of use of heated humidified high-flow nasal cannula therapy in PICUs in the United Kingdom and Republic of Ireland. Pediatr Crit Care Med 2019; 20(3):223-32.
34) Metge P, Grimaldi C, Hassid S, Thomachot L, Loundou A, Martin C, et al. Comparison of high-flow humidified nasal cannula to nasal continuous with acute bronchiolitis: experience in a pediatric intensive care unit. Eur J Pediatr 2014; 173:953-8.
35) Milési C, Essouri S, Pouyal R, Liet JM, Afanetti M, Portefaix A, et al. High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med 2017; 43:209-16.
36) Shein SL, Slain K, Wilson-Costello D, McKee B, Rotta AT. Temporal changes of prescription of neuropharmacological drugs and utilization of resources related to neurologic morbidity in mechanically ventilated children with bronchiolitis. Pediatr Crit Care Med 2017; 18(12):e606-14.
37) Horvat CM, Clark RS. Healthcare in the PICU may be more complicated than we thought-we knew?. Pediatr Crit Care Med 2017; 18(12):1188-9.
38) Baudin F. Viral bronchiolitis in PICUs: looking further than the acute phase!. Pediatr Crit Care Med 2017; 18(12):1178-9.
2) Harish N, Simoes E, Rudan I, Gessner B, Azziz-Baumgartner E, Zhang JSF. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet 2013; 381(9875):1380-90.
3) Hancock DG, Charles-Britton B, Dixon DL, Forsyth KD. The heterogeneity of viral bronchiolitis: a lack of universal consensus definitions. Pediatr Pulmonol 2017: 52(9):1234-40. doi: 10.1002/ppul.23750.
4) Korppi M, Mecklin M, Heikkilä P. Review shows substantial variations in the use of medication for infant bronchiolitis between and within countries. Acta Paediatr 2019; 108(6):1016-22.
5) Rodríguez-Martínez C, Castro-Rodriguez J, Nino G, Midulla F. The impact f viral bronchiolitis phenotyping: is time to consider phenotype-specific responses to individualize phamacological management?. Paediatr Respir Rev 2020; 34:53-8. doi: 10.1016/j.prrv.2019.04.003
6) Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134(5):e1474-502.
7) Martínez Blanco B, Martinón-Torres F. ¿Es urgente actualizar las guías de práctica clínica españolas para el tratamiento de la bronquiolitis aguda?. An Pediatr (Barc) 2016; 85(2):106-8.
8) Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Eng J Med 2018; 378(2):1121-31.
9) Dohna-Schwake C, Mücher K, Stehling F, Rothoeft T, Roll C, Brevis Nuńez F, et al. Differences for medical care for acute severe viral bronchiolitis in two urbans areas in Europe. Klin Padiatr 2018; 230:245-50.
10) González-Dambrauskas S, Díaz F, Carvajal C, Monteverde-Fernández N, Serra A. La Colaboración para mejorar los cuidados médicos de nuestros niños. El desarrollo de una Red Pediátrica Latinoamericana: LARed. Arch Pediatr Urug 2018; 89(3):194-202.
11) Harris P, Taylor R, Thielke R, col. Research electronic data capture (REDCap—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2):377-81.
12) Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infection. Am Rev Respir Dis 1992; 145:106-9.
13) Liu LL, Gallaher MM, Davis RL, Rutter CM, Lewis TC, Marcuse EK. Use of a respiratory clinical score among different providers. Pediatr Pulmonol 2004; 37(3):243-8.
14) Wood DW, Downes JJ, Lecks HI. A clinical scoring system for the diagnosis of respiratory failure. Preliminary report on childhood status asthmaticus. Am J Dis Child 1972; 123: 227-8.
15) Pollack MM, Holubkov R, Glass P, Dean JM, Meert KL, Zimmerman J, et al. Functional Status Scale: a new pediatric outcome measure. Pediatrics 2009; 124(1):e18-28.
16) Moynihan K, McSharry B, Reed P, Dphil PR, Buckley D. Impact of retrieval, distance travelled and referral center on outcomes in unplanned admissions to a national ICU. Pediatr Crit Care Med 2016; 17:e34-42.
17) Kawaguchi A, Saunders LD, Yasui Y, DeCaen A. Effects of medical transport on outcomes in children requiring intensive care. J Intensive Care Med 2018; 35(9):889-95. doi: 10.1177/0885066618796460.
18) Gazhaly M, Nadel S. Characteristic of children admitted to intensive care with acute bronchiolitis. Eur J Pediatr 2018; 177:913-20.
19) Morosini F, Notejane M, Machado K, Paéz M, Rompani E, Taboada R, et al. Ventilación no invasiva y oxigenoterapia de alto flujo en salas de cuidados moderados. Experiencia en la Unidad de Cuidados Especiales Respiratorios Agudos del Hospital Pediátrico del CHPR durante 2013-2016. Arch Pediatr Urug 2018; 89(2):78-85.
20) Clayton J, McKee B, Slain CN, Rotta AT, Shein SL. Outcomes of children with bronchiolitis treated with high-flow nasal cannula or non-invasive pressure ventilation. Pediatr Crit Care Med 2019; 20(2):128-35.
21) Ramos-Fernández JM, Pedrero-Segura E, Gutiérrez-Bedmar M, Delgado-Martín B, Cordón-Martínez AM, Moreno-Pérez D, et al. Epidemiología de los ingresos por bronquiolitis en el sur de Europa: análisis de las epidemias 2010-2015. An Pediatr (Barc) 2017; 87(5):260-8.
22) Flores-González J, Valladares CM, Yun-Castilla C, Mayordomo-Colunga J, Quesada SP, Martín Delgado CM, et al. Association of fluid overload in critically ill children with bronchiolitis: bronquiolitis en la Unidad de Cuidados Intensivos Pediátricos (BRUCIP) Study. Pediatr Crit Care Med 2019; 20(3):e130-6.
23) Jacobs A, Flechet M, Vanhorebeek I, Verstraete S, Ingels C, Casaer MP, et al. Performance of pediatric mortality prediction scores for PICU mortality and 90-days mortality. Pediatr Crit Care Med 2019; 20(2):113-9.
24) Giachetto G, Vomero A, Pandolfo S, Notejane M, García L, Cavallieri F, et al. Validación del score clínico de Tal modificado para la evaluación de severidad en bronquiolitis. Arch Pediatr Urug 2018; 89(Suppl. 1):43-8.
25) Pérez W, Giachetto G, García L, Vomero A, Pandolfo S, Cavallieri F, et al. Opinión de expertos sobre el artículo “Validación del score clínico de Tal modificado para la evaluación de severidad en bronquiolitis”. Arch Pediatr Urug 2019; 90(3):89-94.
26) Duarte-Dorado DM, Madero-Orostegui DS, Rodriguez-Martinez CE, Nino G. Validation of a scale to assess the severity of bronchiolitis in a population of hospitalized infants. J Asthma 2013; 50(10):1056-61. doi: 10.3109/02770903.2013.834504.
27) Serra JA, González-Dambrauskas S, Vásquez Hoyos P, Carvajal C, Donoso A, Cruces P, et al. Variabilidad terapéutica en lactantes con bronquiolitis hospitalizados en unidades de cuidados intensivos latinoamericanas. Rev Chil Pediatr 2020; 91(2):216-25. doi:10.32641/rchped.v91i2.1156.
28) Pilar Orive FJ, López Fernández Y; UCIP. Hospital de Cruces. Guía para el manejo de la bronquiolitis aguda. Sociedad y Fundación Española de Cuidados Intensivos Pediátricos, 2013. Disponible en: http://secip.com/wp-content/uploads/2018/06/Protocolo-Bronquiolitis-2013.pdf [Consulta: 6 junio 2019].
29) Oakley E, Brys T, Borland M, Neutze J, Philipps N, Krieser D, et al. Medication use in infants admitted with bronchiolitis. Emerg Med Australas 2018; 30(3):389-97.
30) National Institute for Health and Care Excellence. Bronchiolitis in children: diagnosis and management. June 2015. Disponible en: http:/www.nice.org.uk/guidance/ng9 [Consulta: junio 2016].
31) Stobbelaar K, Kool M, de Kruijf D, Van Hoorenbeck K, Jorens P, De Doooy J, et al. Nebulised hypertonic saline in children with bronchiolitis admitted to the paediatric intensive care unit: a retrospective study. J Paediatr Child Health 2019; 55(9):1125-32. doi: 10.1111/jpc.1437.
32) Shein SL, Kong M, McKee E, O´Riordan MA, Toltzis P, Randolph AG. Antibiotic prescription in young children with respiratory syncytial virus-associated respiratory failure and associated outcomes. Pediatr Crit Care Med 2019; 20(2):101-9.
33) Morris JV, Kapetanstrataki M, Parslow RC, Davis PJ, Ramnarayan P. Patterns of use of heated humidified high-flow nasal cannula therapy in PICUs in the United Kingdom and Republic of Ireland. Pediatr Crit Care Med 2019; 20(3):223-32.
34) Metge P, Grimaldi C, Hassid S, Thomachot L, Loundou A, Martin C, et al. Comparison of high-flow humidified nasal cannula to nasal continuous with acute bronchiolitis: experience in a pediatric intensive care unit. Eur J Pediatr 2014; 173:953-8.
35) Milési C, Essouri S, Pouyal R, Liet JM, Afanetti M, Portefaix A, et al. High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med 2017; 43:209-16.
36) Shein SL, Slain K, Wilson-Costello D, McKee B, Rotta AT. Temporal changes of prescription of neuropharmacological drugs and utilization of resources related to neurologic morbidity in mechanically ventilated children with bronchiolitis. Pediatr Crit Care Med 2017; 18(12):e606-14.
37) Horvat CM, Clark RS. Healthcare in the PICU may be more complicated than we thought-we knew?. Pediatr Crit Care Med 2017; 18(12):1188-9.
38) Baudin F. Viral bronchiolitis in PICUs: looking further than the acute phase!. Pediatr Crit Care Med 2017; 18(12):1178-9.
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Published
2021-05-18
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Martínez-Arroyo L, Díaz-Rubio F, González-Dambrauskas S, Monteverde-Fernández N, Serra A, Pedrozo Ortiz LE, et al. Bronchiolitis admissions in 13 pediatric intensive care units in Uruguay: Is it the same in Montevideo (capital city) and the provinces?. Rev. Méd. Urug. [Internet]. 2021 May 18 [cited 2024 Sep. 16];37(2):e37207. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/708
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