Abstract
Bronchiolitis was found to be the greatest worldwide cause of infant hospitalization presenting with symptoms of cough, wheezes, difficulty in breathing, decreased feeding, and apneas. It is estimated that 1-3% of hospitalized infants will require treatment in an intensive care unit especially when risk factors are present. This study analyzes the use of Non-invasive ventilation (NIV) in severe bronchiolitis and its role in reducing the rate of ventilator associated pneumonia (VAP), and the duration of oxygen requirement. Data were collected retrospectively through PHENIX; hospital electronic system for infants less than one year old. Shortness of breath, cough, apnea, cyanosis, N-CPAP immediate or later after few hours, mechanical ventilation (MV), length of hospital stay, and survival status were the outcome variables. Mann-Whitney U test was performed via SPSS version 25.0.Fifty-five infants with bronchiolitis were admitted with forty-nine episodes receiving NIV or MV. A total of thirty-seven infants were treated with NIV while 15 infants were treated with MV. Fever was the major indication for initiating NIV among infants followed by cough, apnea, and shortness of breath. Insignificant evidence was reported between baseline respiratory parameters and infants receiving NIV and MV. Changes in respiratory variables in the first four hours showed significant increase for infants receiving NIV than those receiving MV. Infants receiving NIV had significantly fewer days in NIV and PICU, but insignificant fewer days in hospital stay. The experience for using NIV in infants admitted for bronchiolitis recommends that NIV might be adjunct to mechanical ventilation. This strategy was related with a lower rate of pneumonia and a shorter duration of oxygen therapy.
Highlights
Acute respiratory failure is accountable for 4.25 million deaths globally from influenza, pneumonia, respiratory syncytial virus and is the predominant cause of mortality in low and middle-income countries [1]
Mechanical ventilation was provided to 8 infants (14.5%) after Continuous positive airway pressure (CPAP); whereas, non-invasive ventilation was majorly provided to infants in ER (67.3%)
Few attempts have explored the outcomes of responders and non-responders, and this study has presented short-term results of a cohort of infants with severe bronchiolitis treated with non-invasive ventilation (NIV) [27]
Summary
Acute respiratory failure is accountable for 4.25 million deaths globally from influenza, pneumonia, respiratory syncytial virus and is the predominant cause of mortality in low and middle-income countries [1]. Respiratory failure has been reported in one-third of unplanned infant admissions to pediatric intensive care units (PICUs), majorly because of bronchiolitis. These admissions need a prolonged hospital stay and invasive mechanical ventilation [8]. The use of non-invasive ventilation (NIV) in pediatric acute respiratory failure of variable outcomes has been supported in a study [11]. While in the year 2000, other non-invasive modalities were introduced [13] In this retrospective study, the use of NIV decreased the rate of ventilator-associated pneumonia and reduced the duration of oxygen requirement without prolonging the hospital stay. To show more evidence as well as predict process success
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