Intensive care unit admissions and ventilation support in infants with bronchiolitis

Ed Oakley, Vi Chong, Meredith Borland, Jocelyn M. Neutze, Natalie T. Phillips, David Krieser, Stuart R. Dalziel, Andrew Davidson, Susan Donath, Kim Jachno, Mike South, Amanda Fry, Franz E. Babl

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    Abstract

    Objectives: To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis. Design: Retrospective review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2–12 months old admitted with bronchiolitis. Setting: Seven Australian and New Zealand hospitals. These infants were prospectively identified through the comparative rehydration in bronchiolitis (CRIB) study between 2009 and 2011. Results: Of 3884 infants identified, 3589 charts were available for analysis. Of 204 (5.7%) infants with bronchiolitis admitted to ICU, 162 (79.4%) received ventilation support. Of those 133 (82.1%) received non-invasive ventilation (high flow nasal cannula [HFNC] or continuous positive airway pressure [CPAP]) 7 (4.3%) received invasive ventilation alone and 21 (13.6%) received a combination of ventilation modes. Infants with comorbidities such as chronic lung disease (OR 1.6 [95% CI 1.0–2.6]), congenital heart disease (OR 2.3 [1.5–3.5]), neurological disease (OR 2.2 [1.2–4.1]) or prematurity (OR 1.5 [1.0–2.1]), and infants 2–6 months of age (OR 1.5 [1.1–2.0]) were more likely to be admitted to ICU. Respiratory syncitial virus positivity did not increase the likelihood of being admitted to ICU (OR 1.1 [95% CI 0.8–1.4]). HFNC use changed from 13/53 (24.5% [95% CI 13.7–38.3]) patient episodes in 2009 to 39/91 (42.9% [95% CI 32.5–53.7]) patient episodes in 2011. Conclusion: Admission to ICU is an uncommon occurrence in infants admitted with bronchiolitis, but more common in infants with comorbidities and prematurity. The majority are managed with non-invasive ventilation, with increasing use of HFNC.

    LanguageEnglish
    Pages421-428
    Number of pages8
    JournalEMA - Emergency Medicine Australasia
    Volume29
    Issue number4
    DOIs
    StatePublished - 1 Aug 2017

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    Bronchiolitis
    Intensive Care Units
    Ventilation
    Noninvasive Ventilation
    New Zealand
    Comorbidity
    Continuous Positive Airway Pressure
    Hospital Records
    Fluid Therapy
    Critical Care
    Lung Diseases
    Registries
    Heart Diseases
    Chronic Disease
    Pediatrics
    Viruses

    Cite this

    Oakley, E., Chong, V., Borland, M., Neutze, J. M., Phillips, N. T., Krieser, D., ... Babl, F. E. (2017). Intensive care unit admissions and ventilation support in infants with bronchiolitis. EMA - Emergency Medicine Australasia, 29(4), 421-428. DOI: 10.1111/1742-6723.12778
    Oakley, Ed ; Chong, Vi ; Borland, Meredith ; Neutze, Jocelyn M. ; Phillips, Natalie T. ; Krieser, David ; Dalziel, Stuart R. ; Davidson, Andrew ; Donath, Susan ; Jachno, Kim ; South, Mike ; Fry, Amanda ; Babl, Franz E./ Intensive care unit admissions and ventilation support in infants with bronchiolitis. In: EMA - Emergency Medicine Australasia. 2017 ; Vol. 29, No. 4. pp. 421-428
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    abstract = "Objectives: To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis. Design: Retrospective review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2–12 months old admitted with bronchiolitis. Setting: Seven Australian and New Zealand hospitals. These infants were prospectively identified through the comparative rehydration in bronchiolitis (CRIB) study between 2009 and 2011. Results: Of 3884 infants identified, 3589 charts were available for analysis. Of 204 (5.7{\%}) infants with bronchiolitis admitted to ICU, 162 (79.4{\%}) received ventilation support. Of those 133 (82.1{\%}) received non-invasive ventilation (high flow nasal cannula [HFNC] or continuous positive airway pressure [CPAP]) 7 (4.3{\%}) received invasive ventilation alone and 21 (13.6{\%}) received a combination of ventilation modes. Infants with comorbidities such as chronic lung disease (OR 1.6 [95{\%} CI 1.0–2.6]), congenital heart disease (OR 2.3 [1.5–3.5]), neurological disease (OR 2.2 [1.2–4.1]) or prematurity (OR 1.5 [1.0–2.1]), and infants 2–6 months of age (OR 1.5 [1.1–2.0]) were more likely to be admitted to ICU. Respiratory syncitial virus positivity did not increase the likelihood of being admitted to ICU (OR 1.1 [95{\%} CI 0.8–1.4]). HFNC use changed from 13/53 (24.5{\%} [95{\%} CI 13.7–38.3]) patient episodes in 2009 to 39/91 (42.9{\%} [95{\%} CI 32.5–53.7]) patient episodes in 2011. Conclusion: Admission to ICU is an uncommon occurrence in infants admitted with bronchiolitis, but more common in infants with comorbidities and prematurity. The majority are managed with non-invasive ventilation, with increasing use of HFNC.",
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    author = "Ed Oakley and Vi Chong and Meredith Borland and Neutze, {Jocelyn M.} and Phillips, {Natalie T.} and David Krieser and Dalziel, {Stuart R.} and Andrew Davidson and Susan Donath and Kim Jachno and Mike South and Amanda Fry and Babl, {Franz E.}",
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    Oakley, E, Chong, V, Borland, M, Neutze, JM, Phillips, NT, Krieser, D, Dalziel, SR, Davidson, A, Donath, S, Jachno, K, South, M, Fry, A & Babl, FE 2017, 'Intensive care unit admissions and ventilation support in infants with bronchiolitis' EMA - Emergency Medicine Australasia, vol 29, no. 4, pp. 421-428. DOI: 10.1111/1742-6723.12778

    Intensive care unit admissions and ventilation support in infants with bronchiolitis. / Oakley, Ed; Chong, Vi; Borland, Meredith; Neutze, Jocelyn M.; Phillips, Natalie T.; Krieser, David; Dalziel, Stuart R.; Davidson, Andrew; Donath, Susan; Jachno, Kim; South, Mike; Fry, Amanda; Babl, Franz E.

    In: EMA - Emergency Medicine Australasia, Vol. 29, No. 4, 01.08.2017, p. 421-428.

    Research output: Contribution to journalArticle

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    T1 - Intensive care unit admissions and ventilation support in infants with bronchiolitis

    AU - Oakley,Ed

    AU - Chong,Vi

    AU - Borland,Meredith

    AU - Neutze,Jocelyn M.

    AU - Phillips,Natalie T.

    AU - Krieser,David

    AU - Dalziel,Stuart R.

    AU - Davidson,Andrew

    AU - Donath,Susan

    AU - Jachno,Kim

    AU - South,Mike

    AU - Fry,Amanda

    AU - Babl,Franz E.

    PY - 2017/8/1

    Y1 - 2017/8/1

    N2 - Objectives: To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis. Design: Retrospective review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2–12 months old admitted with bronchiolitis. Setting: Seven Australian and New Zealand hospitals. These infants were prospectively identified through the comparative rehydration in bronchiolitis (CRIB) study between 2009 and 2011. Results: Of 3884 infants identified, 3589 charts were available for analysis. Of 204 (5.7%) infants with bronchiolitis admitted to ICU, 162 (79.4%) received ventilation support. Of those 133 (82.1%) received non-invasive ventilation (high flow nasal cannula [HFNC] or continuous positive airway pressure [CPAP]) 7 (4.3%) received invasive ventilation alone and 21 (13.6%) received a combination of ventilation modes. Infants with comorbidities such as chronic lung disease (OR 1.6 [95% CI 1.0–2.6]), congenital heart disease (OR 2.3 [1.5–3.5]), neurological disease (OR 2.2 [1.2–4.1]) or prematurity (OR 1.5 [1.0–2.1]), and infants 2–6 months of age (OR 1.5 [1.1–2.0]) were more likely to be admitted to ICU. Respiratory syncitial virus positivity did not increase the likelihood of being admitted to ICU (OR 1.1 [95% CI 0.8–1.4]). HFNC use changed from 13/53 (24.5% [95% CI 13.7–38.3]) patient episodes in 2009 to 39/91 (42.9% [95% CI 32.5–53.7]) patient episodes in 2011. Conclusion: Admission to ICU is an uncommon occurrence in infants admitted with bronchiolitis, but more common in infants with comorbidities and prematurity. The majority are managed with non-invasive ventilation, with increasing use of HFNC.

    AB - Objectives: To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis. Design: Retrospective review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2–12 months old admitted with bronchiolitis. Setting: Seven Australian and New Zealand hospitals. These infants were prospectively identified through the comparative rehydration in bronchiolitis (CRIB) study between 2009 and 2011. Results: Of 3884 infants identified, 3589 charts were available for analysis. Of 204 (5.7%) infants with bronchiolitis admitted to ICU, 162 (79.4%) received ventilation support. Of those 133 (82.1%) received non-invasive ventilation (high flow nasal cannula [HFNC] or continuous positive airway pressure [CPAP]) 7 (4.3%) received invasive ventilation alone and 21 (13.6%) received a combination of ventilation modes. Infants with comorbidities such as chronic lung disease (OR 1.6 [95% CI 1.0–2.6]), congenital heart disease (OR 2.3 [1.5–3.5]), neurological disease (OR 2.2 [1.2–4.1]) or prematurity (OR 1.5 [1.0–2.1]), and infants 2–6 months of age (OR 1.5 [1.1–2.0]) were more likely to be admitted to ICU. Respiratory syncitial virus positivity did not increase the likelihood of being admitted to ICU (OR 1.1 [95% CI 0.8–1.4]). HFNC use changed from 13/53 (24.5% [95% CI 13.7–38.3]) patient episodes in 2009 to 39/91 (42.9% [95% CI 32.5–53.7]) patient episodes in 2011. Conclusion: Admission to ICU is an uncommon occurrence in infants admitted with bronchiolitis, but more common in infants with comorbidities and prematurity. The majority are managed with non-invasive ventilation, with increasing use of HFNC.

    KW - bronchiolitis

    KW - continuous positive airway pressure

    KW - high flow nasal cannula

    KW - intensive care unit

    KW - intubation

    KW - non-invasive ventilation

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    Oakley E, Chong V, Borland M, Neutze JM, Phillips NT, Krieser D et al. Intensive care unit admissions and ventilation support in infants with bronchiolitis. EMA - Emergency Medicine Australasia. 2017 Aug 1;29(4):421-428. Available from, DOI: 10.1111/1742-6723.12778