Abstract
Objectives: Bronchiolitis is the most common lower respiratory tract infection in infancy and about 6-15% of patients of acute bronchiolitis require ventilatory support. Non Invasive Ventilation by increasing Mean Airway Pressure reduces airway resistance and recruits non-functional respiratory units to improve oxygenation. The objective of this study is to determine the effectiveness of Non Invasive Ventilation in patients of severe acute bronchiolitis. Methods: The present observational descriptive study was conducted in the department of Paediatrics, Dr. B.C. Roy Post Graduate Institute of Paediatric sciences, Kolkata, India. Those patients fulfilling the criteria for severe Acute Bronchiolitis according to Bronchiolitis Scoring System were included in this study. 76 patients were studied during the 1 year period from April 2014 to March 2015. Results: A success rate of 72.4% has been observed in this study. Mean duration of Non Invasive Ventilation in patients where it was successful was 32.5±15.3 hours. Abnormalities in pH and PCO2 improved over a period of 6 hours. Conclusion: Non Invasive Ventilation was found effective in 72.4% of patients of severe bronchiolitis. Abnormalities in pH & PCO2 were also improved over 6 hours. Thus, it is an effective, safe and cost effective modality of treatment of severe bronchiolitis.
Highlights
Bronchiolitis is an acute inflammatory respiratory illness of lower respiratory tract of children that occurs in the first 2 years of life and characterized by fever, rhinitis followed by tachypnea, expiratory wheezing, and increased respiratory effort
Before instituting Non Invasive Ventilation (NIV) support, Arterial Blood Gas (ABG) analysis done for all these patients to look for pH, PO2, PCO2, HCO3, Base Excess (BE) using OPTI-CCA cassette
If the SpO2 could not be maintained using a PEEP of 7cmH2O and FiO2 of 70% or the Bronchiolitis Scoring System (BSS) score and ABG deteriorate or same after 6 hours of instituting NIV, these patients are categorised as NIV failed cases and treated with intubation and Invasive Mechanical Ventilation initiated without any delay
Summary
Bronchiolitis is an acute inflammatory respiratory illness of lower respiratory tract of children that occurs in the first 2 years of life and characterized by fever, rhinitis followed by tachypnea, expiratory wheezing, and increased respiratory effort. Bronchiolitis occurs in a seasonal pattern with peak incidence in the winter to spring months. Several viral agents have been identified as etiology of bronchiolitis, like respiratory syncytial virus (RSV), parainfluenza, adenovirus, influenza, and rhinovirus, with RSV being the most prevalent. According to WHO bulletin, an estimated 150 million new cases occur annually. 11-20 million (7-13%) of these cases are severe enough to require hospital admission. 95% of all cases occur in developing countries [1]. Bronchiolitis is an important public health problem imposing tremendous burden on the existing medical care facility
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