Burden of disease and change in practice in critically ill infants with bronchiolitis

Schlapbach, Luregn J.; Straney, Lahn; Gelbart, Ben; Alexander, Janet; Franklin, Donna; Beca, John; Whitty, Jennifer A.; Ganu, Subodh; Wilkins, Barry; Slater, Anthony; Croston, Elizabeth; Erickson, Simon; Schibler, Andreas

doi:10.1183/13993003.01648-2016

Cited by 104 publications

(111 citation statements)

References 34 publications

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“…HHHFNC treatment achieved a wide popularity to reduce the rate of intubation and ICU admission. Previous studies reported that the overall rate of intubation and ICU admission declined 50%‐70% in patients with bronchiolitis by HHHFNC therapy . However, the optimal flow rate to provide the lowest intubation rate and ICU admission in the ED setting is still unknown.…”

Section: Discussionmentioning

confidence: 99%

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

Yurtseven

Turan

Erseven

et al. 2019

Pediatric Pulmonology

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Objective We aimed to compare the heated humidiﬁed high‐ﬂow nasal cannula (HHHFNC) flow rate of 1‐L·kg·min−1 (1 L) with 2‐L·kg·min −1 (2 L) in patients with severe bronchiolitis presenting to the pediatric emergency department. Study design We performed a study in which all patients were allocated to receive these two flow rates. The primary outcome was admitted as treatment failure, which was defined as a clinical escalation in respiratory status. Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), the clinical respiratory score (CRS), rise of peripheral capillary oxygen saturation (SpO2), and rates of weaning, intubation, and intensive care unit (ICU) admission. Results One hundred and sixty‐eight cases (88 received the 1‐L flow rate and 80, the 2‐L flow rate) were included in the analyses. Treatment failure was 11.4% (10 of 88) in the 1‐L group, and 10% (8 of 80) in the 2‐L group (P = .775). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, the rate of weaning (53.4% vs 35%; P = .017), the falling down of the CRS (−2.1 vs −1.5; P < .001), RR (−15.2 vs −11.8; P < .001), and HR (− 24.8 vs − 21.2; P < .001), and the increase of SpO 2 (4.8 vs 3.6; P < .001) were significantly more evident in the 1‐L group. Conclusion HHHFNC with the 1‐L·kg·min−1 flow rate, which provides a more frequent earlier effect, reached therapy success as high as the 2‐L·kg·min −1 flow rate in patients with severe acute bronchiolitis.

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Section: Discussionmentioning

confidence: 99%

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

Yurtseven

Turan

Erseven

et al. 2019

Pediatric Pulmonology

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“…1,2 In Australia and New Zealand, there has been a population-based increase in admissions to the intensive care unit (ICU) for bronchiolitis, with associated increases in hospital costs. 3 Numerous studies have investigated the role of medical therapies 4 in infants with bronchiolitis; none of these interventions have shown efficacy. 5 The American Academy of Pediatrics guidelines recommend only supportive therapy that includes oxygen therapy for hypoxemia, respiratory support, and the maintenance of hydration.…”

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confidence: 99%

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

et al. 2018

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BACKGROUNDHigh-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. METHODSIn this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high-flow oxygen therapy (high-flow group) or standard oxygen therapy (standard-therapy group). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting ≥3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events. RESULTSThe analyses included 1472 patients. The percentage of infants receiving escalation of care was 12% (87 of 739 infants) in the high-flow group, as compared with 23% (167 of 733) in the standard-therapy group (risk difference, −11 percentage points; 95% confidence interval, −15 to −7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1% of infants) occurred. Among the 167 infants in the standard-therapy group who had treatment failure, 102 (61%) had a response to high-flow rescue therapy. CONCLUSIONSAmong infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy. Original ArticleThe New England Journal of Medicine 1122T h e ne w e ngl a nd jou r na l o f m e dicine B ronchiolitis, an acute lower airway lung disease that is generally caused by respiratory viruses, is the most common reason worldwide for nonelective hospital admission in infants. In the United States, bronchiolitis is responsible for $1.7 billion in hospitalization costs annually.1,2 In Australia and New Zealand, there has been a population-based increase in admissions to the intensive care unit (ICU) for bronchiolitis, with associated increases in hospital costs. 3Numerous studies have investigated the role of medical therapies 4 in infants with bronchiolitis; none of these interventions have shown efficacy. 5The American Academy of Pediatrics guidelines recommend only supportive therapy that includes oxygen therapy for hypoxemia, respiratory support, and the maintenance of hydration. 5,6 Respiratory support as provided in emergency and ward settings has been limited to oxygen delivered through a standard nasal cannula, at a rate of up to 2 li...

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“…Infant bronchiolitis is a major cause of PICU admissions in children. For example, it caused 27.6% of non‐elective PICU admissions in a multicentre study from Australia and New Zealand . Annual direct hospitalisation costs due to severe bronchiolitis increased during the 13‐year study period from 11.4 million Australian dollars in 2002 to 44.3 million dollars in 2014.…”

Section: Discussionmentioning

confidence: 99%

“…Annual direct hospitalisation costs due to severe bronchiolitis increased during the 13‐year study period from 11.4 million Australian dollars in 2002 to 44.3 million dollars in 2014. The 2014 figures were based on 1528 bronchiolitis patients who were treated in 10 PICUs and 19 general intensive care units …”

Section: Discussionmentioning

confidence: 99%

Nursing intensity scores did not correlate well with reimbursement claims for infant bronchiolitis

et al. 2019

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Aim We retrospectively evaluated the hospital reimbursement rates for inpatient bronchiolitis treatment and then compared them to the RAFAELA® nursing intensity scores. Methods We selected all 44 bronchiolitis patients treated in the paediatric intensive care unit (PICU) and then for each PICU‐treated patient two patients treated on the ward (n = 88) under 12 months of age in 2010‐2015. The data included medical histories, hospital reimbursement rates using the Nordic Diagnosis Related Groups (NordDRG) or expense categories and the RAFAELA® scores. Results Reimbursement claims were mostly based on expense categories for PICU admissions and NordDRG categories for ward admissions. The median (range) was €6352 (€1330‐30 554) and €2009 (€768‐6027) per episode for the PICU and ward cases, respectively. The median lengths of hospital stay were 8.5 days (3‐18) and 3 days (1‐8), respectively. Higher RAFAELA® scores were associated with nasal continuous positive airway pressure therapy and mechanical ventilation in the PICU and oxygen supplementation and nasogastric tube feeding on the ward. The correlation coefficients between RAFAELA® scores and hospital reimbursement claims ranged from 0.121‐0.450. Conclusion Hospital reimbursement claim for a PICU admission was three times as much as a ward admission and reimbursement claims for bronchiolitis did not match with nursing intensity scores.

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Burden of disease and change in practice in critically ill infants with bronchiolitis

Cited by 104 publications

References 34 publications

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

Nursing intensity scores did not correlate well with reimbursement claims for infant bronchiolitis

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Burden of disease and change in practice in critically ill infants with bronchiolitis

Cited by 104 publications

References 34 publications

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min−1 vs 2‐L·kg·min−1) in the management of acute bronchiolitis

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min−1 vs 2‐L·kg·min−1) in the management of acute bronchiolitis

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

Nursing intensity scores did not correlate well with reimbursement claims for infant bronchiolitis

Contact Info

Product

Resources

About

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis

Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min⁻¹ vs 2‐L·kg·min⁻¹) in the management of acute bronchiolitis