ICU Use in Bronchiolitis: Why Has It Doubled?

Abstract

* Abbreviations: HFNC — : high-flow nasal cannula therapy NIV — : noninvasive ventilation PHIS — : Pediatric Health Information System database Health care expenditures make up a large and increasing proportion of the US gross domestic product. Pediatrics is not immune to the problem, because expenditures on child health services are now equivalent to half of the US defense budget.1 Trends in our most common pediatric inpatient diagnoses, such as bronchiolitis, provide insight into the problem. Despite an apparent decrease in hospitalizations for bronchiolitis, overall costs continue to rise.2 In this month’s issue of Pediatrics , Pelletier et al3 provide further information on the phenomenon of rising resource use for bronchiolitis. These investigators demonstrated a dramatic increase in ICU use for bronchiolitis over 10 years, without clear evidence for an increase in severity of the illness itself. Indeed, there is some evidence to the contrary, with stable to declining length of stay and frequency of invasive ventilation. In the last year of the study, 2019, nearly a quarter of bronchiolitis patients in these Pediatric Health Information System database (PHIS) hospitals were cared for in an ICU. Another notable trend was … Address correspondence to Brian Alverson, MD, Department of Pediatrics, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. E-mail: balverson{at}lifespan.org