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Intensivists' Reported Management of Critical Bronchiolitis: More Data and New Guidelines Needed
Adrian D Zurca1, Sebastián González-Dambrauskas2,3, Jose Colleti4
1Penn State Children's Hospital, Hershey, Pennsylvania.
Insights
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.
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.
Objectives:
Existing bronchiolitis guidelines do not reflect the needs of infants admitted to the PICU. This study aimed to identify PICU providers' reported practice variations and explore the need for critical bronchiolitis clinical guidelines.
Methods:
Cross-sectional electronic survey available in English, Spanish, and Portuguese between November 2020 and March 2021, distributed via research networks from North and Latin America, Asia, and Australia/New Zealand.
Results:
A total of 657 PICU providers responded, including 344 English, 204 Spanish, and 109 Portuguese. PICU providers indicated frequently using (≥25% of time) diagnostic modalities for nonintubated and intubated patients on PICU admission (complete blood count [75%-97%], basic metabolic panel [64%-92%], respiratory viral panel [90%-95%], chest x-ray [83%-98%]). Respondents also reported regularly (≥25% of time) prescribing β-2 agonists (43%-50%), systemic corticosteroids (23%-33%), antibiotics (24%-41%), and diuretics (13%-41%). Although work of breathing was the most common variable affecting providers' decision to initiate enteral feeds for nonintubated infants, hemodynamic status was the most common variable for intubated infants (82% of providers). Most respondents agreed it would be beneficial to have specific guidelines for infants with critical bronchiolitis who are requiring both noninvasive (91% agreement) and invasive (89% agreement) respiratory support.
Conclusions:
PICU providers report performing diagnostic and therapeutic interventions for infants with bronchiolitis more frequently than recommended by current clinical guidelines, with interventions occurring more frequently for infants requiring invasive support. More clinical research is needed to inform the creation of evidence-based guidelines specifically for infants with critical bronchiolitis.
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