Respiratory Support Practices for Bronchiolitis in the Pediatric Intensive Care Unit.

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Medicine
• Health Services Research

Background:

• Pediatric intensive care unit (PICU) admissions for bronchiolitis have been increasing.
• The association between this rise and evolving noninvasive respiratory support practices remains unclear.

Purpose of the Study:

• To determine if PICU admissions for bronchiolitis between 2013 and 2022 correlated with changes in the utilization of high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV).
• To identify factors associated with the success and failure of HFNC and NIV in treating bronchiolitis.

Main Methods:

• A cross-sectional study analyzing 33,816 patient encounters for bronchiolitis across 27 PICUs from 2013-2022.
• Linear regression assessed trends in admissions and ventilation use; multivariable logistic regression identified factors influencing HFNC/NIV success and failure.

Main Results:

• PICU admissions for bronchiolitis increased by 350 encounters annually. HFNC use rose by 242 encounters/year and NIV by 126 encounters/year; IMV use remained stable.
• Successful HFNC use increased from 79.8% in 2013 to 84.0% in 2022; successful NIV use rose from 73.2% to 84.0% over the same period.
• Lower weight, higher Pediatric Risk of Mortality III scores, cardiac disease, and non-emergency department admissions were associated with higher odds of HFNC and NIV failure.

Conclusions:

• PICU admissions for bronchiolitis tripled between 2013-2022, accompanied by a 4.8-fold increase in HFNC use and a 5.8-fold increase in NIV use.
• Standardizing HFNC and NIV support protocols for bronchiolitis is crucial to mitigate increasing resource strain.
• Further research is warranted to optimize noninvasive respiratory support strategies in pediatric critical care for bronchiolitis.