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Nasal CPAP in the Pediatric Ward to Reduce PICU Admissions for Severe Bronchiolitis?

Melodie O Aricò1, Diana Wrona2, Giovanni Lavezzo2

  • 1Department of Pediatrics, G.B. Morgagni-L. Pierantoni Hospital, AUSL Romagna, 48018 Forli, Italy.

Pediatric Reports
|October 24, 2023
PubMed

Insights

Continuous positive airway pressure (CPAP) for infant bronchiolitis can be safely managed on a general pediatric ward. This approach reduces pediatric intensive care unit (PICU) admissions during outbreaks.

Area of Science:

  • Pediatrics
  • Respiratory Medicine

Background:

  • Acute bronchiolitis in infants frequently necessitates transfer to a pediatric intensive care unit (PICU) for continuous positive airway pressure (CPAP) therapy.
  • Managing CPAP in a general pediatric ward can alleviate PICU strain during bronchiolitis outbreaks.

Purpose of the Study:

  • To evaluate the feasibility and safety of managing infants with bronchiolitis using CPAP in a general pediatric ward.
  • To assess the impact of ward-based CPAP on PICU admission rates.

Main Methods:

  • Retrospective collection of clinical data from infants under 12 months admitted for bronchiolitis between October 2021 and March 2023.
  • Comparison of outcomes between infants treated with nasal CPAP (nCPAP) in the general ward and those receiving other oxygen support methods or no support.

Main Results:

  • Out of 82 infants, 16 received nCPAP, with only 3 (19%) requiring PICU transfer due to clinical deterioration.
  • The majority of infants (50%) did not require oxygen support, while others received low-flow or high-flow nasal cannulas.
  • No infants with coinfection (RSV/SARS-CoV-2) or SARS-CoV-2 infection required oxygen support.

Conclusions:

  • Nasal CPAP therapy for infant bronchiolitis can be safely and effectively administered in a general pediatric ward setting.
  • Implementing ward-based CPAP can significantly reduce the need for PICU admissions, optimizing resource allocation.
  • Successful implementation requires comprehensive staff training, vigilant patient monitoring, and strong collaboration with the PICU.

Keywords:
bronchiolitis respiratory syncytial viruscontinuous positive air pressurehigh-flow nasal cannulaoxygen administrationpediatric intensive care unitpediatric ward

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