Increasing burden of viral bronchiolitis in the pediatric intensive care unit; an observational study

Linssen, Rosalie S.N.; Teirlinck, Anne; Boven, Michiel van; Biarent, Dominique; Stona, Luca; Amigoni, Angela; Comoretto, Rosanna Irene; Leteurtre, Stéphane; Bruandet, A.; Bentsen, Gunnar; Drage, Inger Marie; Wang, Xin; Campbell, Harry; Woensel, Job B. M. van; Bont, Louis; Reinout, A.

doi:10.1016/j.jcrc.2021.07.009

Cited by 24 publications

(25 citation statements)

References 11 publications

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“…The yearly prevalence showed a downward trend from 11% to 7%. This prevalence is lower than that described in studies from other countries, where their prevalence ranged from 17 to 20% [ 1 , 16 , 17 ]. Although the study design and inclusion criteria are important confounding factors when comparing these prevalence determinations, differences in prevalence or severity may exist between different locations even when applying the same study criteria, as Lonngren et al illustrated in their comparison of the United Kingdom and South Africa study sites [ 3 ].…”

Section: Discussioncontrasting

confidence: 74%

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The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience

Al‐Eyadhy

Almazyad

Hasan

et al. 2023

Journal of Infection and Chemotherapy

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Section: Discussioncontrasting

confidence: 74%

“…Common viral infections represent a significant burden in the PICU [ 16 ]. Our study explored the prevalence and types of viral infections in a tertiary PICU setting over three-year period.…”

Section: Discussionmentioning

confidence: 99%

The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience

Al‐Eyadhy

Almazyad

Hasan

et al. 2023

Journal of Infection and Chemotherapy

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“…Viral bronchiolitis can cause acute respiratory failure and is one of the most common causes for admission to a PICU [5][6][7] . Such critically ill children are often supported with non-invasive positive pressure ventilation (NIPPV) or high-flow nasal cannula (HFNC) respiratory support modalities.…”

Section: Background and Significancementioning

confidence: 99%

“…After introduction of the bronchiolitis CDS tool, there was a statistically significant improvement (decrease) in which of the following clinical outcomes as compared to the patients managed during the initial QI initiative? Black/African American, n (%) 43 (7) 8 ( 5) 27 ( 9) 8 ( 6)…”

Section: Multiple Choice Questionsmentioning

confidence: 99%

Improving Pediatric Intensive Care Unit Discharge Timeliness of Infants with Bronchiolitis Using Clinical Decision Support

et al. 2023

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BACKGROUND: Identifying children ready for transfer out of the pediatric ICU (PICU) is an area that may benefit from clinical decision support (CDS). We previously implemented a quality improvement (QI) initiative to accelerate the transfer evaluation of non-medically-complex PICU patients with viral bronchiolitis receiving floor-appropriate respiratory support. OBJECTIVES: Design a CDS tool adaptation of this QI initiative to further accelerate transfer evaluation of appropriate patients. METHODS: The original initiative focused on identifying for transfer evaluation otherwise healthy children admitted to the PICU with bronchiolitis who had been receiving floor-appropriate levels of respiratory support for at least 6-hours. However, this initiative required that clinicians manually track the respiratory support of qualifying patients. We designed an electronic health record (EHR)-based CDS tool to automate identification of transfer-ready candidates. The tool parses EHR data to identify children meeting prior QI initiative criteria and alerts clinicians to assess transfer readiness once a child has been receiving floor-appropriate respiratory support for 6-hours. We compared time from reaching floor-appropriate support to placement of the transfer order (“time-to-transfer"), PICU LOS, and hospital LOS between patients admitted prior to our QI initiative (12/1/2018-10/19/2019, “pre-QI-phase”), during the initiative but before CDS tool implementation (10/20/2019-2/7/2022, “QI-phase”), and after CDS implementation (2/8/2022-11/11/2022, “CDS-phase”). RESULTS: CDS-phase patients (n=131) had a shorter median time-to-transfer of 5.23 (IQR 3.38-10.0) hours compared to QI-phase patients (n=304) at 5.93 (4.23-12.2) hours (p=0.04). PICU and hospital LOS values decreased from the pre-QI (n=150) to QI-phase. Though LOS reductions were sustained during the CDS-phase, further reductions from QI to CDS-phase were not statistically significant. CONCLUSIONS: An EHR-based CDS adaptation of a prior QI initiative facilitated timely identification of PICU patients with bronchiolitis ready for transfer evaluation. Such tools might allow PICU clinicians to focus on other high-acuity tasks while accelerating transfer evaluation of appropriate patients.

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“…Bronchiolitis is the most common hospitalised acute lower respiratory tract infection (ALRI) in children in western countries 1 . In Europe, bronchiolitis is responsible for 80 paediatric intensive care unit admissions per 100.000 children each year 2 . Respiratory syncytial virus (RSV) is a leading causative agent of bronchiolitis, detected in 62 to 87% of hospitalised cases 3 .…”

Section: Introductionmentioning

confidence: 99%

Respective roles of non-pharmaceutical interventions in bronchiolitis outbreaks: an interrupted time-series analysis based on a multinational surveillance system

Lenglart

Ouldali

Honeyford³

et al. 2022

Eur Respir J

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BackgroundBronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of SARS-CoV-2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries.MethodsWe conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of the 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling.ResultsIn total, 42 916 children were included. We observed an overall cumulative 78% reduction (95%CI [−100;−54], p<0.0001) in bronchiolitis cases following NPI implementation. The decrease varied between countries from −97% (95%CI [−100;−47], p=0.0005) to −36% (95%CI [−79;+07], p=0.105). Full lockdown (IRR 0.21, 95%CI [0.14;0.30], p<0.001), secondary-school closure (IRR 0.33, 95%CI [0.20;0.52], p<0.0001), wearing a mask indoors (IRR 0.49, 95%CI [0.25;0.94], p=0.034), and teleworking (IRR 0.55, 95%CI [0.31;0.97], p=0.038) were independently associated with reducing bronchiolitis.ConclusionSeveral NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis.

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Increasing burden of viral bronchiolitis in the pediatric intensive care unit; an observational study

Cited by 24 publications

References 11 publications

The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience

The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience

Improving Pediatric Intensive Care Unit Discharge Timeliness of Infants with Bronchiolitis Using Clinical Decision Support

Respective roles of non-pharmaceutical interventions in bronchiolitis outbreaks: an interrupted time-series analysis based on a multinational surveillance system

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