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4.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32661190

RESUMO

BACKGROUND AND OBJECTIVES: International patterns of antibiotic use and laboratory testing in bronchiolitis in emergency departments are unknown. Our objective is to evaluate variation in the use of antibiotics and nonindicated tests in infants with bronchiolitis in 38 emergency departments in Pediatric Emergency Research Networks in Canada, the United States, Australia and New Zealand, the United Kingdom and Ireland, and Spain and Portugal. We hypothesized there would be significant variation, adjusted for patient characteristics. METHODS: We analyzed a retrospective cohort study of previously healthy infants aged 2 to 12 months with bronchiolitis. Variables examined included network, poor feeding, dehydration, nasal flaring, chest retractions, apnea, saturation, respiratory rate, fever, and suspected bacterial infection. Outcomes included systemic antibiotic administration and urine, blood, or viral testing or chest radiography (CXR). RESULTS: In total, 180 of 2359 (7.6%) infants received antibiotics, ranging from 3.5% in the United Kingdom and Ireland to 11.1% in the United States. CXR (adjusted odds ratio [aOR] 2.3; 95% confidence interval 1.6-3.2), apnea (aOR 2.2; 1.1-3.5), and fever (aOR 2.4; 1.7-3.4) were associated with antibiotic use, which did not vary across networks (P = .15). In total, 768 of 2359 infants (32.6%) had ≥1 nonindicated test, ranging from 12.7% in the United Kingdom and Ireland to 50% in Spain and Portugal. Compared to the United Kingdom and Ireland, the aOR (confidence interval) results for testing were Canada 5.75 (2.24-14.76), United States 4.14 (1.70-10.10), Australia and New Zealand 2.25 (0.86-5.74), and Spain and Portugal 3.96 (0.96-16.36). Testing varied across networks (P < .0001) and was associated with suspected bacterial infections (aOR 2.12; 1.30-2.39) and most respiratory distress parameters. Viral testing (591 of 768 [77%]) and CXR (507 of 768 [66%]) were obtained most frequently. CONCLUSIONS: The rate of antibiotic use in bronchiolitis was low across networks and was associated with CXR, fever, and apnea. Nonindicated testing was common outside of the United Kingdom and Ireland and varied across networks irrespective of patient characteristics.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/estatística & dados numéricos , Bronquiolite/tratamento farmacológico , Técnicas de Laboratório Clínico/estatística & dados numéricos , Técnicas de Diagnóstico do Sistema Respiratório/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Apneia/etiologia , Australásia , Bronquiolite/complicações , Bronquiolite/diagnóstico , Criança , Pré-Escolar , Uso de Medicamentos/estatística & dados numéricos , Europa (Continente) , Feminino , Febre/etiologia , Humanos , Internacionalidade , Masculino , América do Norte , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos
8.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675334

RESUMO

BACKGROUND: Because of the impact of continuous pulse oximetry (CPOX) on the overdiagnosis of hypoxemia in bronchiolitis, the American Academy of Pediatrics and the Choosing Wisely campaign have issued recommendations for intermittent monitoring. Parental preferences for monitoring may impact adoption of these recommendations, but these perspectives are poorly understood. METHODS: Using this cross-sectional survey, we explored parental perspectives on CPOX monitoring before discharge and 1 week after bronchiolitis hospitalizations. During the 1-week call, half of the participants were randomly assigned to receive a verbal statement on the potential harms of CPOX to determine if conveying the concept of overdiagnosis can change parental preferences on monitoring frequency. An aggregate variable measuring favorable perceptions of CPOX was created to determine CPOX affinity predictors. RESULTS: In-hospital interviews were completed on 357 patients, of which 306 (86%) completed the 1-week follow-up. Although 25% of parents agreed or strongly agreed that hospital monitors made them feel anxious, 98% agreed that the monitors were helpful. Compared to other vital signs, respiratory rate (87%) and oxygen saturation (84%) were commonly rated as "extremely important." Providing an educational statement on CPOX comparatively decreased parental desire for continuous monitoring (40% vs 20%; P < .001). Although there were no significant predictors of CPOX affinity, the effect size of the educational intervention was higher in college-educated parents. CONCLUSIONS: Parents find security in CPOX. A brief statement on the potential harms of CPOX use had an impact on stated monitoring preferences. Parental perspectives are important to consider because they may influence the adoption of intermittent monitoring.


Assuntos
Bronquiolite/terapia , Hospitalização , Monitorização Fisiológica , Oximetria , Pais , Atitude Frente a Saúde , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto , Estudos Prospectivos , Taxa Respiratória , Inquéritos e Questionários
11.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32551095

RESUMO

Bronchiolitis is injury to the bronchioles (small airways with a diameter of 2 mm or less) resulting in inflammation and/or fibrosis. Bronchioles can be involved in pathologic processes that involve predominantly the lung parenchyma or large airways, but, in some diseases, bronchioles are the main site of injury ("primary bronchiolitis"). Acute bronchiolitis caused by viruses is responsible for most cases of bronchiolitis in infants and children. In adults, however, there is a wide spectrum of bronchiolar disorders and most are chronic. Many forms of bronchiolitis have been described in the literature, and the terminology in this regard remains confusing. In clinical practice, a classification scheme based on the underlying histopathologic pattern (correlates with presenting radiologic abnormalities) facilitates the recognition of bronchiolitis and the search for the inciting cause of the lung injury. Respiratory bronchiolitis is the most common form of bronchiolitis in adults and is usually related to cigarette smoking. Currently, the diagnosis of respiratory bronchiolitis is generally achieved based on the clinical context (smoking history) and chest CT findings. Constrictive (obliterative) bronchiolitis is associated with airflow obstruction and is seen in various clinical contexts including environmental/occupational inhalation exposures, transplant recipients (bronchiolitis obliterans syndrome), and many others. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is increasingly recognized and can be associated with progressive airflow obstruction related to constrictive bronchiolitis ("DIPNECH syndrome"). Diffuse aspiration bronchiolitis is a form of aspiration-related lung disease that is often unsuspected and confused for interstitial lung disease. Novel forms of bronchiolitis have been described, including lymphocytic bronchiolitis and alveolar ductitis with emphysema recently described in employees at a manufacturing facility for industrial machines. Bronchiolitis is also a component of vaping-related lung injury encountered in the recent outbreak.


Assuntos
Bronquiolite , Vaping , Adulto , Humanos , Inflamação , Tomografia Computadorizada por Raios X
19.
Harefuah ; 159(5): 349-351, 2020 May.
Artigo em Hebraico | MEDLINE | ID: mdl-32431125

RESUMO

INTRODUCTION: Inhalations of hypertonic saline is a known therapy for infants diagnosed with acute bronchiolitis. Recent meta-analysis has shown that it can reduce the length of hospitalization and decrease the chances of admission. AIMS: To assess the extent of use of hypertonic saline inhalations in the pediatric wards in Israel in 2018. METHODS: During October 2018 a detailed questionnaire was emailed to all the managers of pediatric wards in Israel. The questions related to treatments given to infants with acute bronchiolitis in pediatric wards and emergency departments in 2018. All results underwent statistical analysis. RESULTS: A total of 22/28 (78%) of all pediatric wards managers completed the questionnaire; 17/22 (77%) routinely use hypertonic saline in their wards. In 15 out of the 17 wards the hypertonic saline is also provided at their emergency department. In 12 wards (70%) the saline is provided together with a bronchodilator, in 4 (24%) with inhaled steroids, and in 2 (12%) with adrenaline. CONCLUSIONS: In most pediatric wards and their emergency departments in Israel, hypertonic saline with bronchodilators is routinely used to treat infants with acute bronchiolitis.


Assuntos
Bronquiolite , Nebulizadores e Vaporizadores , Doença Aguda , Criança , Humanos , Lactente , Israel , Solução Salina Hipertônica
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