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Respiratory and pharmacological management in severe acute bronchiolitis: Were clinical guidelines not written for critical care?
Marcos-Morales, A; García-Salido, A; Leoz-Gordillo, I; de Lama Caro-Patón, G; Martínez de Azagra-Garde, A; García-Teresa, M Á; Iglesias-Bouzas, M I; Nieto-Moro, M; Serrano-González, A; Casado-Flores, J.
Afiliação
  • Marcos-Morales A; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
  • García-Salido A; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain. Electronic address: citopensis@yahoo.es.
  • Leoz-Gordillo I; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
  • de Lama Caro-Patón G; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
  • Martínez de Azagra-Garde A; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
  • García-Teresa MÁ; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
  • Iglesias-Bouzas MI; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
  • Nieto-Moro M; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
  • Serrano-González A; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
  • Casado-Flores J; Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
Arch Pediatr ; 28(2): 150-155, 2021 Feb.
Article em En | MEDLINE | ID: mdl-33339722
ABSTRACT

PURPOSE:

The treatment applied for children admitted to the pediatric intensive care unit (PICU) for severe acute bronchiolitis may differ from general recommendations. The first objective of our study was to describe the treatments offered to these children in a Spanish tertiary PICU. The second objective was to analyse the changes in management derived from the publication of the American Academy of Pediatrics (AAP) bronchiolitis guideline in 2014.

METHODS:

This was a retrospective-prospective observational study conducted during two epidemic waves (2014-2015 and 2015-2016). The AAP guidelines were distributed and taught to PICU staff between both epidemic waves.

RESULTS:

A total of 138 children were enrolled (78 male). In the first period, 78 children were enrolled. The median age was 1.8 months (IQR 1.1-3.6). There were no differences between the management in the two periods, except for the use of high-flow oxygen therapy (HFOT); its use increased in the second period. Overall, 83% of patients received non-invasive ventilation or HFOT. Children older than 12 months received HFOT exclusively. In comparison, continuous positive airway pressure and bi-level positive airway pressure were used less during the period 2015-2016 (P=0.036). Regarding pharmacological therapy, 70% of patients received antibiotics, 23% steroids, 33% salbutamol, 31% adrenaline, and 7% hypertonic saline. The mortality rate was zero.

CONCLUSIONS:

Our PICU did not follow the AAP recommendations. There were no differences between the two periods, except in the use of HFOT. All children older than 12 months received HFOT exclusively. The rate of using invasive mechanical ventilation was also low.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Terapia Respiratória / Padrões de Prática Médica / Broncodilatadores / Bronquiolite / Fidelidade a Diretrizes / Anti-Inflamatórios / Antibacterianos Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Infant / Male / Newborn País/Região como assunto: Europa Idioma: En Revista: Arch Pediatr Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Espanha

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Terapia Respiratória / Padrões de Prática Médica / Broncodilatadores / Bronquiolite / Fidelidade a Diretrizes / Anti-Inflamatórios / Antibacterianos Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Infant / Male / Newborn País/Região como assunto: Europa Idioma: En Revista: Arch Pediatr Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Espanha