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Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting
Ruth Walsh1, Liam Costello2, Alexandria DiCosimo2
1Discipline of Paediatrics, School of Medicine, Trinity College Dublin, the University of Dublin, College Green, Dublin, 2, Ireland. walshr21@tcd.ie.
Insights
Severe bronchiolitis management in infants often excludes high-risk cases. More research is needed to understand effective treatments for these vulnerable infants in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric Intensive Care
- Neonatal Medicine
- Respiratory Medicine
Background:
- Severe bronchiolitis is a common respiratory illness in infants.
- Management strategies in pediatric intensive care units (PICUs) require further investigation, especially for high-risk infants.
- Current evidence-based knowledge on managing severe bronchiolitis in PICU settings is limited.
Purpose of the Study:
- To systematically review the management of severe bronchiolitis in infants within a PICU.
- To focus on identifying evidence gaps for high-risk infants with severe bronchiolitis.
- To inform future research and clinical practice for this patient demographic.
Main Methods:
- Systematic literature review adhering to Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P).
- Searched Embase, PubMed, and Medline databases for studies on PICU management of bronchiolitis in infants under 24 months.
- Included studies with evidence levels I, II, and III.
Main Results:
- 26 studies met inclusion criteria from 455 reviewed papers.
- 19 studies focused on respiratory interventions (e.g., positive airway pressure, oxygen delivery).
- 7 studies examined other therapies (e.g., dexamethasone, Heliox, diuretics); 20 studies excluded high-risk infants. Favorable outcomes noted for Heliox, prophylactic dexamethasone, protein supplementation, and diuretics.
Conclusions:
- Clinical trials for bronchiolitis management frequently exclude high-risk infants.
- There is a need for innovative study designs to improve access for high-risk infants.
- Randomized controlled trials are essential to establish effective management strategies for bronchiolitis in high-risk infants in PICU settings.
Aim:
Systematically review the management of infants with severe bronchiolitis in a paediatric intensive care unit (PICU) setting with a focus on high-risk infants to identify gaps in evidence-based knowledge.
Methods:
This systematic review utilised Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to examine the literature on the PICU management of bronchiolitis in infants <24 months old. Three databases, Embase, PubMed and Medline, were searched and higher levels of evidence I, II and III were included.
Results:
There were 455 papers reviewed and 26 met the inclusion criteria. Furthermore, 19 of these studied respiratory interventions such as positive airway pressure and oxygen delivery. The remaining 7 examined: erythropoietin, caffeine, dexamethasone, protein supplementation, ribavirin, respiratory syncytial virus immune globulin, or diuretic therapy. Of the 26 studies, 20 excluded infants with high-risk conditions. Therapies showing favourable outcomes included Heliox, prophylactic dexamethasone pre-extubation, protein supplementation, and diuretic use.
Conclusions:
Clinical trials for bronchiolitis management frequently exclude high-risk children. Innovative study design in the future may improve access to clinical trials for the management of bronchiolitis in high-risk infants in a PICU setting.
Impact:
Clinical trials for bronchiolitis management frequently exclude high-risk children. We review the evidence base for the management of an under-investigated patient demographic in the setting of acute bronchiolitis. Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting.
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