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Intensivists' Reported Management of Critical Bronchiolitis: More Data and New Guidelines Needed.

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Pediatric Intensive Care Unit (PICU) providers frequently use diagnostic and therapeutic interventions for infant bronchiolitis that exceed current guidelines. There is a need for evidence-based critical bronchiolitis clinical guidelines for PICU patients.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Illness
  • Clinical Practice Guidelines

Background:

  • Existing bronchiolitis guidelines do not adequately address the needs of infants in the Pediatric Intensive Care Unit (PICU).
  • There is a recognized variation in clinical practice among PICU providers managing infants with bronchiolitis.

Purpose of the Study:

  • To identify practice variations among PICU providers in the management of bronchiolitis.
  • To explore the need for specific clinical guidelines for critical bronchiolitis in the PICU.

Main Methods:

  • A cross-sectional electronic survey was distributed to PICU providers across North and Latin America, Asia, and Australia/New Zealand.
  • The survey was available in English, Spanish, and Portuguese, collecting data between November 2020 and March 2021.

Main Results:

  • 657 PICU providers responded, reporting frequent use of diagnostic tests (e.g., complete blood count, respiratory viral panel, chest x-ray) and therapies (e.g., beta-agonists, corticosteroids, antibiotics, diuretics).
  • Interventions were more common for intubated infants, and most providers agreed on the need for specific guidelines for critical bronchiolitis requiring noninvasive or invasive respiratory support.

Conclusions:

  • PICU providers' reported practices for infant bronchiolitis often exceed current guideline recommendations.
  • Further clinical research is necessary to develop evidence-based guidelines tailored for critically ill infants with bronchiolitis in the PICU.