Emergency room endotracheal intubation in children with bronchiolitis: A cohort study using a multicenter database
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Published on: January 17, 2011
Marla R Carter1, Aamer H Khan1, Tarek Salman1
1Division of Pediatric Critical Care Medicine, Department of Pediatrics Rainbow Babies and Children's Hospital Cleveland Ohio.
Insights
For pediatric patients with bronchiolitis, the location of endotracheal intubation (community vs. children's hospital emergency room) did not significantly impact mechanical ventilation duration or pediatric intensive care unit length of stay.
Area of Science:
- Pediatric critical care medicine
- Respiratory illness research
- Health services research
Background:
- Bronchiolitis and asthma share clinical similarities, impacting treatment strategies.
- Previous studies indicated shorter mechanical ventilation (MV) and pediatric intensive care unit (PICU) length of stay (LOS) for asthma patients intubated in community emergency rooms (ERs).
- The impact of intubation setting on critical bronchiolitis outcomes remains unclear.
Purpose of the Study:
- To investigate whether the emergency room (ER) setting (community vs. children's hospital) influences mechanical ventilation (MV) duration and pediatric intensive care unit (PICU) length of stay (LOS) in infants with bronchiolitis.
- To compare outcomes for pediatric patients with bronchiolitis based on the location of endotracheal intubation.
Main Methods:
- Retrospective analysis of the Virtual Pediatric Systems (VPS) database.
- Inclusion of 1934 patients under 24 months with bronchiolitis and endotracheal tube at PICU admission (2009-2016).
- Multivariable linear regression to assess the association between intubation location (community/external vs. children's hospital/internal ER) and MV duration/PICU LOS, adjusting for confounders.
Main Results:
- The cohort (n=1934) had a median age of 2.0 months; 51% were admitted from external ERs.
- Median MV duration was 6.6 days and median PICU LOS was 7.0 days.
- While initial analysis showed slightly longer MV and PICU LOS for children intubated in children's hospital ERs (P<.001 and P=.004 respectively), multivariable analysis revealed no significant association after adjusting for confounding variables.
Conclusions:
- Unlike findings in near-fatal asthma, the location of endotracheal intubation in either a community or children's hospital emergency room did not significantly affect clinical outcomes for critical bronchiolitis.
- This suggests that the ER setting is not a determining factor for mechanical ventilation duration or PICU length of stay in pediatric bronchiolitis patients.
Background And Aims:
Bronchiolitis and asthma have a clinical overlap, and it has been shown that pediatric intensive care unit (PICU) patients with asthma undergoing endotracheal intubation in a community hospital emergency room (ER) have a shorter duration of mechanical ventilation (MV) and PICU length of stay (LOS) vs children undergoing intubation in a children's hospital. We aimed to determine if the setting of intubation (community vs children's hospital ER) is associated with the duration of MV and PICU LOS among children with bronchiolitis.
Methods:
With IRB approval, data in the Virtual Pediatric Systems (VPS, LLC) database were queried for bronchiolitis patients <24 months of age admitted to one of 103 predominantly North American PICUs between 1/2009 and 1/2016 who had an endotracheal tube in place at PICU admission. There were no exclusion criteria. Extracted data included ER type (community/external or children's hospital/internal), demographics, and reported comorbidities. Outcomes analyzed were duration of MV and PICU LOS. Multivariable linear regression was used to evaluate if intubation location was independently associated with the outcomes of interest.
Results:
Among 1934 patients, median age was 2.0 (IQR: 1.0-4.8) months, 51% were admitted from an external ER, 41% were White, 61% were male, and 28% had ≥1 comorbidity. Median duration of MV was 6.6 (4.6-9.5) days and the median PICU LOS was 7.0 (4.6-10.6) days. Children who underwent endotracheal intubation in a children's hospital ER had a modestly longer duration of MV (6.7 [4.4-9.4] vs 6.5 [5.2-9.6] days, P < .001, Mann-Whitney U) and longer PICU LOS (7.2 [4.8-10.8] vs 6.9 [4.2-10.1] days, P = .004, Mann-Whitney U). After adjusting for confounding variables, we did not observe a significant association between the location of endotracheal intubation and duration of MV or PICU LOS.
Conclusion:
In this cohort, and unlike outcomes of near-fatal asthma, we observed that clinical outcomes of critical bronchiolitis were similar regardless of location of endotracheal intubation.
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