Neurologic and Functional Morbidity in Critically Ill Children With Bronchiolitis*

Abstract

In two large, multicenter databases, neurologic and functional morbidity was common among previously healthy children admitted to the PICU with bronchiolitis. Prospective studies are needed to measure neurologic and functional outcomes using more precise metrics. Identification of modifiable risk factors may subsequently lead to improved outcomes from this common PICU condition.

Emergency room endotracheal intubation in children with bronchiolitis: A cohort study using a multicenter database

“…VPS data, however, are entered by trained personnel and undergo several quality control procedures before inclusion in the database, enabling it to support several prior PICU studies. 14,15,25 Second, the database does not contain data that the clinician may have considered when deciding to perform endotracheal intubation, such as vital signs, physical exam findings, hypercarbia, presence of apnea, and others, making it prone to confounding by indication. Third, endotracheal intubation and weaning from MV were not protocolized, and prior studies show there is tremendous practice variation in severe bronchiolitis.…”

“…Participation in VPS is voluntary and, therefore, may not be fully representative of all PICUs, but approximately one-third of all US PICUs participate in VPS and it has supported several prior research studies. 14,15,26 We reviewed the VPS database for all patients with a primary diagnosis of bronchiolitis between January 2009 and January 2016, as this was the period of data available from VPS when this study was conceived. Patients were included in the analysis if they were 0 to 24 months of age, admitted from an ED to a participating PICU, and had an endotracheal tube in place at the time of PICU admission.…”

“…For each subject, we identified whether they were admitted from the ED of a community hospital or from the ED of a children's hospital. Age, sex, race/ethnicity (as recorded at each VPS center), and comorbidities 15 were also included in our analysis. 14 As previously described, the presence of a significant comorbidity was identified using diagnosis codes that were "present at admission."…”

“…[4][5][6][7][8][9][10][11] Approximately 10% of children hospitalized with bronchiolitis require invasive mechanical ventilation (MV), which has been associated with longer pediatric intensive care unit (PICU) and hospital lengths of stay, exposure to possibly neurotoxic sedative medications, and adverse events, like ventilator-induced lung injury and ventilatorassociated infections. 8,[12][13][14][15][16][17] Recommended therapies for children hospitalized with bronchiolitis are mostly supportive, and practices vary widely. 11,18,19 There are no interventions that have been proven to reduce the need for MV, but both high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) such as continuous positive airway pressure (CPAP) are increasingly used therapies that have been associated with reduced rates of MV compared to historical controls.…”

Long-Term Neurodevelopmental and Functional Outcomes of Normally Developing Children Requiring PICU Care for Bronchiolitis

“…[10][11][12] We previously reported that approximately 15% of critical bronchiolitis patients have evidence of post-PICU morbidity using two multicenter, predominantly administrative databases. 13 However, that estimate relied on crude measures of morbidity such as receipt of rehabilitation services and performance of neuroimaging. In this study, we used more precise tools to assess the long-term outcomes of initially normally developing children who had survived critical bronchiolitis.…”