Prospective Multicentre Study on the Epidemiology and Current Therapeutic Management of Severe Bronchiolitis in Spain

Abstract

Objective. To determine the epidemiology and therapeutic management of patients with severe acute bronchiolitis (AB) admitted to paediatric intensive care units (PICUs) in Spain. Design. Descriptive, prospective, multicentre study. Setting. Sixteen Spanish PICUs. Patients. Patients with severe AB who required admission to any of the participating PICUs over 1 year. Interventions. Both epidemiological variables and medical treatment received were recorded. Results. A total of 262 patients were recruited; 143 were male (54.6%), with median age of 1 month (0–23). Median stay in the PICU was 7 days (1–46). Sixty patients (23%) received no nebuliser treatment, while the rest received a combination of inhalation therapies. One-quarter of patients (24.8%) received corticosteroids and 56.5% antibiotic therapy. High-flow oxygen therapy was used in 14.3% and noninvasive ventilation (NIV) was used in 75.6%. Endotracheal intubation was required in 24.4% of patients. Younger age, antibiotic therapy, and invasive mechanical ventilation (IMV) were risk factors that significantly increased the stay in the PICU. Conclusions. Spanish PICUs continue to routinely use nebulised bronchodilator treatment and corticosteroid therapy. Despite NIV being widely used in this condition, intubation was required in one-quarter of cases. Younger age, antibiotic therapy, and IMV were associated with a longer stay in the PICU.

Respiratory Support during Bronchiolitis Due to One Virus versus More Than One Virus: An Observational Study

“…4,8,11 Despite the abundant literature around this topic, there are few descriptions about the specifics of illness progression once in PICU. 12 With many different respiratory assistance delivery systems now available, it would be useful to know what type and how much of that respiratory support patients with bronchiolitis due to one virus require when compared to bronchiolitis due to more than one virus. 13 This could potentially help clinicians anticipate what degree of respiratory support infants will need when admitted to PICU due to viral bronchiolitis.…”

Benefits of the humidified low‐flow oxygen therapy in infants with mild–moderate bronchiolitis

“…Thus, humidification in low‐flow oxygen therapy should be recommended as a regular clinical practice, as this viral infection is widespread and highly prevalent. In addition, our results may be generalisable to other clinical scenarios in Spain where the management of infants with bronchiolitis is very similar, such as in bronchodilators nebulised with 3% hypertonic saline and when antibiotics are also prescribed (Flores‐González et al., , ). In other countries, clinicians also prescribe antibiotics, bronchodilators and corticosteroids, with examples found in Italy (De Brasi et al., ) or Finland (Elenius et al., ), despite the fact that administering these treatments has not been shown to have conclusive benefits (American Academy of Pediatrics, ).…”

“…The study group (humidified) data were collected in the same seasonal period, 2012–2014, with this group consisting of 48 infants. The prevalence of RSV in the groups was between 70%–83%, similar to the reference population with bronchiolitis in Spain (Flores‐González et al., ).…”

RSV and exposure to cigarette smoking as risk factors for severe bronchiolitis in a tropical country

“…Bronchiolitis is the most common cause of hospitalization in pediatric patients worldwide (1). Among inpatients with bronchiolitis, approximately a quarter have severe bronchiolitis (2,3). The high medical cost associates with severe bronchiolitis impose a relevant economic burden, especially in tropical middle-income countries (4,5).…”