Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Current...

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Autores principales:	Rachel K. Marlow, Sydney Brouillette, Vannessa Williams, Ariann Lenihan, Nichole Nemec, Joseph D. Lukowski, Cheng Zheng, Melissa L. Cullimore, Sidharth Mahapatra
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	acute respiratory failure bacterial pneumonia critical bronchiolitis invasive mechanical ventilation non-invasive respiratory support Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/b0887b56698444e289c56933685ad4f7
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spelling	oai:doaj.org-article:b0887b56698444e289c56933685ad4f72021-11-25T17:14:44ZRisk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis10.3390/children81110352227-9067https://doaj.org/article/b0887b56698444e289c56933685ad4f72021-11-01T00:00:00Zhttps://www.mdpi.com/2227-9067/8/11/1035https://doaj.org/toc/2227-9067The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.Rachel K. MarlowSydney BrouilletteVannessa WilliamsAriann LenihanNichole NemecJoseph D. LukowskiCheng ZhengMelissa L. CullimoreSidharth MahapatraMDPI AGarticleacute respiratory failurebacterial pneumoniacritical bronchiolitisinvasive mechanical ventilationnon-invasive respiratory supportPediatricsRJ1-570ENChildren, Vol 8, Iss 1035, p 1035 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute respiratory failure bacterial pneumonia critical bronchiolitis invasive mechanical ventilation non-invasive respiratory support Pediatrics RJ1-570
spellingShingle	acute respiratory failure bacterial pneumonia critical bronchiolitis invasive mechanical ventilation non-invasive respiratory support Pediatrics RJ1-570 Rachel K. Marlow Sydney Brouillette Vannessa Williams Ariann Lenihan Nichole Nemec Joseph D. Lukowski Cheng Zheng Melissa L. Cullimore Sidharth Mahapatra Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis
description	The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.
format	article
author	Rachel K. Marlow Sydney Brouillette Vannessa Williams Ariann Lenihan Nichole Nemec Joseph D. Lukowski Cheng Zheng Melissa L. Cullimore Sidharth Mahapatra
author_facet	Rachel K. Marlow Sydney Brouillette Vannessa Williams Ariann Lenihan Nichole Nemec Joseph D. Lukowski Cheng Zheng Melissa L. Cullimore Sidharth Mahapatra
author_sort	Rachel K. Marlow
title	Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis
title_short	Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis
title_full	Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis
title_fullStr	Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis
title_full_unstemmed	Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis
title_sort	risk factors associated with mechanical ventilation in critical bronchiolitis
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/b0887b56698444e289c56933685ad4f7
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Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

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