Prise en charge de la bronchiolite aiguë du nourrisson de moins de 1 an : actualisation et consensus médical au sein des hôpitaux universitaires du Grand Ouest (HUGO)

IntroductionAs the most recent French bronchiolitis guidelines were published in 2000, there is a current overinvestigation and an overtreatment of infants hospitalised with bronchiolitis in France. In 2012, the Group of Pediatric University Hospitals in Western France (‘HUGO’) proposed new evidence-based clinical practice guidelines in keeping with the latest international guidelines. We hypothesise that the implementation of these guidelines contributed to the quality improvement of the management of bronchiolitis in our hospital. The aim of this study was to determine the impact of these guidelines on the management of bronchiolitis inpatients.MethodsThis retrospective before/after study design was conducted in the general paediatric unit of a tertiary care French hospital, looking at 1 year before (ie, the winter of 2011–2012) and 1 year after (ie, the winter of 2013–2014) the implementation of the guidelines. Two hundred and eighty bronchiolitis inpatients, all less than 1 year of age, 115 in 2011–2012 and 165 in 2013–2014, were included. The primary outcome we sought to evaluate was the proportion of children administered a diagnostic test associated with a treatment not routinely recommended by the guidelines. As balancing measures, we evaluated the length of stay, the intensive care unit transfer and the readmission rates.ResultsFollowing implementation of the guidelines, use of any given treatment associated with a diagnostic test was reduced by 66% (p<0.001). There were major decreases in the use of chest X-ray (86%vs26%, p<0.001), antibiotics (38%vs13%, p<0.001) and corticosteroids (10%vs3%, p=0.011). Balancing measures were not significantly different.ConclusionsHUGO guidelines were effective at reducing the administration of unnecessary diagnostic tests and medications. This study was the first step in convincing French paediatricians to streamline their practices until updated national guidelines are published.

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“…All these recommendations were summarised in the HUGO bronchiolitis guidelines ()see online supplementary file 1 ). 12 …”

Section: Methodsmentioning

confidence: 99%

“…In order to improve bronchiolitis inpatient management, the Group of Paediatric University Hospitals in Western France (‘HUGO’) published guidelines in 2012 12 that are in accord with the latest international recommendations. In this study, we sought to determine the impact of these HUGO guidelines.…”

Section: Introductionmentioning

confidence: 99%

Retrospective audit of guidelines for investigation and treatment of bronchiolitis: a French perspective

Benhamida

Bihouée

Verstraete

et al. 2017

bmjpo

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“…McConnochie 20 incluyó ese criterio por primera vez en su definición de BA en 1983. Bastantes guías clínicas lo incorporan ahora en sus definiciones [25][26][27]29 . Otras solo advierten de que los episodios repetidos deberían sugerir otros diagnósticos, como asma o «sibilancias inducidas por virus» 10 .…”

Section: Discussionunclassified

Heterogeneidad de criterios en el diagnóstico de bronquiolitis aguda en España

Garcinuño¹,

Praena-Crespo

Mora-Gandarillas³

et al. 2019

Anales de Pediatría

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“…Nonetheless, due to its mucolytic properties HS has been explored as a therapeutic possibility for mucus hypersecretory diseases such as cystic fibrosis (CF) [ 16 ]. HS for bronchiolitis has been fairly extensively studied and favourable effects have been shown [ 17 , 18 ] though due to conflicting results from other trials [ 19 ] the role of HS remains unclear even in infants with bronchiolitis [ 20 ]. HS can enhance mucociliary clearance [ 21 ] but with concerns of eliciting airway hyperresponsiveness and with minimal evidence for clinical improvement it is perhaps unsurprising that we found equipoise to exist regarding administration of HS to intubated asthmatics, with 46% that never administer it.…”

Section: Discussionmentioning

confidence: 99%

Mucolytics for Intubated Asthmatic Children: A National Survey of United Kingdom Paediatric Intensive Care Consultants

Snoek

Brierley

2015

Critical Care Research and Practice

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Aim. The extent to which mucolytics are utilised in mechanically ventilated asthmatic children is unknown. We sought to establish current practice in the United Kingdom (UK) including choice of mucolytic, dose, and frequency of utilisation. Methods. A national electronic survey was distributed to UK consultants during April and May 2014. We were able to identify 168 PICU consultants at 25 institutions to whom we were able to electronically distribute a survey, representing an estimated 81% of UK NHS PICU consultants. Results. Replies were received from 87 consultants at 21 institutions (response rate = 52%). Recombinant human DNase (rhDNase) does get administered by 63% of clinicians, with 54% and 19% that administer hypertonic saline or N-acetylcysteine, respectively. Of those that do administer rhDNase the majority (48%) dilute it with 0.9% saline and blindly administer it, whereas 35% administer rhDNase under bronchoscopic guidance and 17% judge the necessity for bronchoscopy according to clinical severity. 25 respondents described 7 different methods to calculate rhDNase dose. A majority (87%) of respondents expressed an interest to consider enrolling patients into an RCT that evaluates rhDNase. Conclusion. Significant variation exists regarding the necessity for mucolytics, choice of agent, optimal route, and dose in intubated asthmatic children.

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Prise en charge de la bronchiolite aiguë du nourrisson de moins de 1 an : actualisation et consensus médical au sein des hôpitaux universitaires du Grand Ouest (HUGO)

Cited by 29 publications

References 14 publications

Retrospective audit of guidelines for investigation and treatment of bronchiolitis: a French perspective

Retrospective audit of guidelines for investigation and treatment of bronchiolitis: a French perspective

Heterogeneidad de criterios en el diagnóstico de bronquiolitis aguda en España

Mucolytics for Intubated Asthmatic Children: A National Survey of United Kingdom Paediatric Intensive Care Consultants

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