Predictors of Critical Care and Mortality in Bronchiolitis after Emergency Department Discharge

Schuh, Suzanne; Kwong, Jeffrey C.; Holder, Laura; Graves, Erin; Macdonald, Erin M.; Finkelstein, Yaron

doi:10.1016/j.jpeds.2018.04.010

Cited by 24 publications

(18 citation statements)

References 30 publications

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“…Bronchiolitis infection is included among the leading causes of hospitalization and death in pediatrics [1][2][3][4][5]. Bronchiolitis also represents a high economic burden on society and has generated a high hospital cost of around 72 million euros for children under the age of 2 in Portugal between 2000 and 2015 [3].…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis in the pre-COVID-19 pandemic era

et al. 2020

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Introduction The advent of genome amplification assays has allowed description of new respiratory viruses and to reconsider the role played by certain respiratory viruses in bronchiolitis. This systematic review and meta-analysis was initiated to clarify the prevalence of respiratory viruses in children with bronchiolitis in the pre-COVID-19 pandemic era. Methods We performed an electronic search through Pubmed and Global Index Medicus databases. We included observational studies reporting the detection rate of common respiratory viruses in children with bronchiolitis using molecular assays. Data was extracted and the quality of the included articles was assessed. We conducted sensitivity, subgroups, publication bias, and heterogeneity analyses using a random effect model. Results The final meta-analysis included 51 studies. Human respiratory syncytial virus (HRSV) was largely the most commonly detected virus 59.2%; 95% CI [54.7; 63.6]). The second predominant virus was Rhinovirus (RV) 19.3%; 95% CI [16.7; 22.0]) followed by Human bocavirus (HBoV) 8.2%; 95% CI [5.7; 11.2]). Other reported viruses included Human Adenovirus (HAdV) 6.1%; 95% CI [4.4; 8.0]), Human Metapneumovirus (HMPV) 5.4%; 95% CI [4.4; 6.4]), Human Parainfluenzavirus (HPIV) 5.4%; 95% CI [3.8; 7.3]), Influenza 3.2%; 95% CI [2.2; 4.3], Human Coronavirus (HCoV) 2.9%; 95% CI [2.0; 4.0]), and Enterovirus (EV) 2.9%; 95% CI [1.6; 4.5]). HRSV was the predominant virus involved in multiple detection and most codetections were HRSV + RV 7.1%, 95% CI [4.6; 9.9]) and HRSV + HBoV 4.5%, 95% CI [2.4; 7.3]). Conclusions The present study has shown that HRSV is the main cause of bronchiolitis in children, we also have Rhinovirus, and Bocavirus which also play a significant role. Data on the role played by SARS-CoV-2 in children with acute bronchiolitis is needed. Review registration PROSPERO, CRD42018116067.

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Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis in the pre-COVID-19 pandemic era

et al. 2020

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“…La insuficiencia respiratoria aguda es la principal causa infecciosa de mortalidad infantil en Latinoamérica. A pesar de esto, existe muy poca información sobre las distintas etiologías y síndromes clínicos causantes de insuficiencia respiratoria, específicamente bronquio-litis aguda y neumonía por virus respiratorio sincicial (VRS), y su impacto en la morbimortalidad, utilización de los sistemas de salud y recursos en la región [1][2][3][4][5][6][7] . La bronquiolitis aguda es una enfermedad con una baja letalidad, pero hay grupos de pacientes con comorbilidades específicas que han sido reconocidas como factores de riesgo para desarrollar bronquiolitis aguda grave 8,9 .…”

Section: Introductionunclassified

Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis

Serra¹,

González‐Dambrauskas²,

Vásquez‐Hoyos

et al. 2020

Rev Chil Pediatr

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Objetivo: describir las terapias utilizadas en lactantes con bronquiolitis aguda admitidos en 20 Unidades de Cuidados Intensivos (UCI) pediátricos miembros de LARed en 5 países latinoamericanos.Pacientes y Método: Estudio observacional retrospectivo, multicéntrico, de datos del Registro Latinoamericano de Falla Respiratoria Aguda Pediátrica. Se incluyeron niños menores de 2 años ingresados a UCI pediátrica por bronquiolitis aguda comunitaria entre mayo-septiembre 2017. Se recolectaron datos demográficos, clínicos, soporte respiratorio, terapias utilizadas y resultados clínicos. Se realizó análisis de subgrupos según ubicación geográfica, tipo financiación y presencia de academia.Resultados: Ingresaron al registro 1.155 pacientes con falla respiratoria aguda. Seis casos fueron excluidos por no tener formulario completo. De los 1.147 pacientes, 908 eran menores de 2 años. De ellos, 467 tuvieron diagnóstico de bronquiolitis aguda, correspondiendo a la principal causa de ingreso a UCI pediátrica por falla respiratoria aguda (51,4%). Las características demográficas y de gravedad entre los centros fueron similares. El soporte máximo respiratorio más frecuente fue cánula nasal de alto flujo (47%), seguido por ventilación mecánica no invasiva (26%) y ventilación mecánica invasiva (17%), con un coeficiente de variación (CV) amplio entre los centros. Hubo una gran dispersión en uso de terapias, siendo frecuente el uso de broncodilatadores, antibióticos y corticoides, con CV hasta 400%. El análisis de subgrupos mostró diferencias significativas en soporte respiratorio y tratamientos utilizados. Un paciente falleció en esta cohorte.Conclusión: Detectamos gran variabilidad en el soporte respiratorio y tratamientos entre UCI pediátricas latinoamericanas. Esta variabilidad no es explicada por disparidades demográficas ni clínicas. Esta heterogeneidad de tratamientos debería promover iniciativas colaborativas para disminuir la brecha entre la evidencia científica y la práctica asistencial.

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“…Bronchiolitis in infants, and asthma, or pneumonitis in children, are among the leading causes of hospitalization, usually due to hypoxia. [1][2][3][4] In the United States, asthma in children is reportedly responsible for over 120 000 hospitalizations per year, with an estimated annual cost of 500 million US dollars. 5,6 Moreover, bronchiolitis represents one of the greatest burdens for healthcare systems worldwide, 7 with an estimated annual cost of 1.7 billion US dollars in the United States.…”

Section: Introductionmentioning

confidence: 99%

Automatic oxygen flow titration in spontaneously breathing children: An open‐label randomized controlled pilot study

Roué

Delpeut

d'Hennezel

et al. 2020

Pediatric Pulmonology

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Introduction: When children require supplemental oxygen due to acute hypoxemic respiratory distress (AHRD), manual control of the oxygen flow is often difficult and time-consuming, and carries the risk of unrecognized hypoxia and hyperoxia. To date, no automatic oxygen titration system has been developed and evaluated in spontaneously breathing children. Methods: Children between 1 month and 15 years of age receiving supplemental oxygen due to AHRD were recruited within 24 hours following the onset of the O 2 administration in a French University Department of Paediatrics. Patients were randomized to receive either automated oxygen administration using the FreeO2 device, or conventional manual oxygen administration over a maximum period of 6 hours. Stratification was performed to classify the patients into two age groups: 1 month to 2 years of age and 2 to 15 years of age. The primary outcome was % time spent within the SpO 2 target range (92%-98%). Results: 60 patients (30 infants, 30 children) were randomized and 55 could be analyzed for the primary outcome (28 automated, 27 manual). The automated O 2 delivery using the FreeO2 device significantly increased the time spent within the predefined SpO 2 range (94.6% ± 6% vs 76.3% ± 22%, difference [95% confidence interval {CI}] 18.4 [10.1; 26.7]) with less time spent with hypoxemia (1% ± 1.1% vs 15.1% ± 21.8%, difference [95% CI] −14.4 [−22.2; −6.7]). This difference was greater among (2-15 years of age) children, compared to (1 month-2 years of age) infants. Conclusions: The present randomized controlled pilot study indicates that the tested automated closed-loop O 2 titration technology was safe and yielded improved oxygen parameters among spontaneously breathing children. Based on our pilot data, a full randomized controlled trial will be required to verify the potential clinical benefits.

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Predictors of Critical Care and Mortality in Bronchiolitis after Emergency Department Discharge

Cited by 24 publications

References 30 publications

Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis in the pre-COVID-19 pandemic era

Systematic review and meta-analysis of the prevalence of common respiratory viruses in children < 2 years with bronchiolitis in the pre-COVID-19 pandemic era

Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis

Automatic oxygen flow titration in spontaneously breathing children: An open‐label randomized controlled pilot study

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