AimsThe utilisation of blood gas analysis (BGA) in acute bronchiolitis is common with wide variation between hospitals. Guidelines recommend its use only in those with severe respiratory distress and who are tiring but evidence for such practice is sparse. This study investigated clinical indicators that demarcate clinically important rise in carbon dioxide (CO2).MethodsWe undertook a prospective observational study of children admitted from the emergency department (ED) to a tertiary care university hospital with a diagnosis of bronchiolitis (October 2014–January 2015). Data was obtained from hospital charts and electronic patient information and analysed using STATA/IC 12.1 for Mac. Univariate analysis examined the correlation between blood gas CO2 and oxygen requirement, SpO2 in air, vital signs, feeding support requirement, gender, age, co-morbidities and history of prematurity. Statistically significant variables were entered into a logistic regression model.Results220 patients with bronchiolitis were admitted (mean age of 0.57 years (95% CI:0.05,0.64)). 113 (51%) had at least one BGA done. Those with more than three BGAs (32/113 (28%)) were significantly younger and more likely to be premature. 14% (30/220) were admitted to intensive/high dependency care (ITU/HDU). In ED a CO2 >7kPA was associated with an admission to HDU/ITU (OR 3.75(95% CI:1.13,12.47), p = 0.031); prematurity and young age also independently predicted ITU/HDU (IRR1.53(95% CI:1.21,1.93), p < 0.0001 and IRR0.68(95% CI:0.53,0.86), p = 0.001 respectively). All but one patient with CO2 >7kPa in ED were < 3m and/or premature. Length of stay (LOS) was also significantly longer in this patient group. For BGA taken during the admission, only oxygen requirement and age (particularly <3months (m)) were significantly associated with CO2 >7kPa in the regression model (OR 2.46(95% CI:1.42,4.26), p = 0.001 and OR 0.08(95% CI:0.03,0.17), p < 0.001; respectively). There was no association between amount of oxygen supplied and level of CO2 measured. Overall, LOS was significantly higher in those who had BGA during admission (4.0 days (d) (95% CI 3.5,4.5) versus 2.3d (95% CI:2.0,2.6)).ConclusionAge under 3 months, history of prematurity and CO2 >7kPa done in ED identify those with prolonged LOS and/or HDU/ITU admission. Significantly raised CO2 is not seen in bronchiolitis without oxygen requirement. Further work will look to elucidate when BGA may be helpful in the management of bronchiolitis.
disordered breathing. Guidelines recommend overnight oximetry in infancy and annually until the ages 3-5 years. To audit adherence to guidelines regarding surveillance of sleep disordered breathing. To estimate the prevalence of sleep disordered breathing, severity and requirement of intervention within our population. Methods We undertook a retrospective case note audit of children cared for within the Down syndrome service 2010-2019. Studies undertaken outside of the surveillance period (older than 5 years) were not included. Results 102 children, aged between 27 days and 5.8 years, underwent 343 overnight oximetry studies (range 1-11 studies per child). Comorbidities included congenital heart disease (62); pulmonary hypertension (12); prematurity (8); airway abnormality not including adenotonsillar hypertrophy (10). Only two children did not have a significant comorbidity. 41 children had a study suggestive of sleep disordered breathing. 18 children underwent adenotonsillectomy. Three children required tracheostomy and invasive ventilation. 4 received non-invasive ventilation. 16 children did not have a study (of whom 9 moved out of area). Conclusion The guidelines were followed in 93% of cases. The proportion of children with significant comorbidities was high. One third of children in this group had sleep disordered breathing of whom over half required significant intervention.
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