Burden of disease and change in practice in critically ill infants with bronchiolitis

Schlapbach, Luregn J., Straney, Lahn, Gelbart, Ben, Alexander, Janet, Franklin, Donna, Beca, John, Whitty, Jennifer A. ORCID: https://orcid.org/0000-0002-5886-1933, Ganu, Subodh, Wilkins, Barry, Slater, Anthony, Croston, Elizabeth, Erickson, Simon and Schibler, Andreas and Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE), Australian & New Zealand Intensive Care Society (ANZICS) Paediatric Study Group (2017) Burden of disease and change in practice in critically ill infants with bronchiolitis. European Respiratory Journal, 49 (6). ISSN 0903-1936

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Abstract

Bronchiolitis represents the most common cause of non-elective admission to paediatric intensive care units (ICUs). We assessed changes in admission rate, respiratory support, and outcomes of infants <24 months with bronchiolitis admitted to ICU between 2002 and 2014 in Australia and New Zealand. During the study period, bronchiolitis was responsible for 9628 (27.6%) of 34 829 non-elective ICU admissions. The estimated population-based ICU admission rate due to bronchiolitis increased by 11.76 per 100 000 each year (95% CI 8.11–15.41). The proportion of bronchiolitis patients requiring intubation decreased from 36.8% in 2002, to 10.8% in 2014 (adjusted OR 0.35, 95% CI 0.27–0.46), whilst a dramatic increase in high-flow nasal cannula therapy use to 72.6% was observed (p<0.001). We observed considerable variability in practice between units, with six-fold differences in risk-adjusted intubation rates that were not explained by ICU type, size, or major patient factors. Annual direct hospitalisation costs due to severe bronchiolitis increased to over USD30 million in 2014. We observed an increasing healthcare burden due to severe bronchiolitis, with a major change in practice in the management from invasive to non-invasive support that suggests thresholds to admittance of bronchiolitis patients to ICU have changed. Future studies should assess strategies for management of bronchiolitis outside ICUs.

Item Type:	Article
Uncontrolled Keywords:	infant,ventilation,bronchiolitis,intensive care,high-flow nasal cannulae
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Health Economics Faculty of Medicine and Health Sciences > Research Groups > Respiratory and Airways Group Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research
Depositing User:	Pure Connector
Date Deposited:	07 Mar 2017 01:45
Last Modified:	03 Nov 2022 15:42
URI:	https://ueaeprints.uea.ac.uk/id/eprint/62870
DOI:	10.1183/13993003.01648-2016

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