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Management of severe bronchiolitis: impact of NICE guidelines
Benedict Griffiths1, Shelley Riphagen1, Jon Lillie1
1South Thames Retrieval Service, Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK.
Insights
Despite National Institute for Health and Care Excellence (NICE) guidelines, nebulised therapy use increased for infants with bronchiolitis. This study examined management changes in paediatric intensive care unit (PICU) referrals before and after NICE guidance.
Area of Science:
- Pediatric critical care medicine
- Respiratory infections
- Evidence-based medicine
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- National Institute for Health and Care Excellence (NICE) provides guidelines for bronchiolitis management.
- Paediatric intensive care units (PICUs) manage severe cases.
Purpose of the Study:
- To evaluate the impact of NICE bronchiolitis guidelines on clinical practice.
- To assess changes in management for children referred to PICU with bronchiolitis.
- To analyze treatment trends before and after NICE guideline implementation.
Main Methods:
- Retrospective analysis of children referred to a PICU transport service.
- Data collected during two winter periods: pre-NICE guidance (2011-2012) and post-NICE guidance (2015-2016).
- Assessment of management initiated by referring hospitals.
Main Results:
- Nebuliser use significantly increased from 28% to 53% post-guidelines.
- Increased use of high-flow nasal cannula oxygen was observed.
- Continuous positive airway pressure use decreased, while antibiotic use remained unchanged.
Conclusions:
- The use of nebulised therapies for severe bronchiolitis has increased.
- Current clinical practice deviates from NICE recommendations regarding nebulised treatments.
- Further research may be needed to understand the reasons for non-adherence to guidelines.
Objective:
To understand the impact of the National Institute for Health and Care Excellence (NICE) bronchiolitis guidelines on the management of children referred to paediatric intensive care unit (PICU) with bronchiolitis.
Design And Setting:
Data were collected on all children referred to a regional PICU transport service with the clinical diagnosis of bronchiolitis during the winter prior to the NICE consultation period (2011-2012) and during the winter after publication (2015-2016). Management initiated by the referring hospital was assessed.
Results:
There were 165 infants referred with bronchiolitis in epoch 1 and 187 in epoch 2. Nebuliser use increased from 28% in epoch 1 to 53% in epoch 2. Increased use of high-flow nasal cannula oxygen and reduction in continuous positive airway pressure use were observed. The use of antibiotics did not change between epochs.
Conclusion:
The use of nebulised therapies has increased in the management of severe bronchiolitis despite national guidance to the contrary.
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