Invasive Mechanical Ventilation for Acute Viral Bronchiolitis: Retrospective Multicenter Cohort Study

Area of Science:

• Pediatric critical care medicine
• Respiratory medicine
• Neonatology

Background:

• Bronchiolitis is a primary reason for pediatric intensive care unit (PICU) admission and resource use.
• Management protocols for mechanically ventilated infants with bronchiolitis lack standardization.
• Significant variations in clinical practices and patient outcomes may exist between PICUs.

Purpose of the Study:

• To investigate inter-center variations in the management of mechanically ventilated bronchiolitis patients.
• To determine if observed management differences correlate with variations in PICU outcomes.

Main Methods:

• Retrospective cohort study of 462 infants under 1 year old across three London tertiary PICUs (2012-2016).
• Data collected included sedative agents, 48-hour fluid balance, and endotracheal tube placement.
• Primary outcome: duration of invasive mechanical ventilation, analyzed using a generalized linear model with confounder adjustment.

Main Results:

• Center A utilized more benzodiazepine/opiate sedation, fewer nasal endotracheal tubes, and had higher fluid balance compared to other centers.
• Center A showed an adjusted mean invasive mechanical ventilation duration 44% longer than Center C (p < 0.001).
• Confounders like corrected gestational age demonstrated significant associations with ventilation duration, particularly in preterm infants.

Conclusions:

• Significant variations in bronchiolitis management practices and patient outcomes exist between PICUs.
• Further research, potentially through implementation science and "optimal care bundles," is needed to explore the relationship between practice variations and outcomes.