Aims & Objectives:
To describe variability of intensive care practices in children with bronchiolitis admitted to 20 PICUs across 5 latinamerican countries during 2017 winter season.
Prospective, observational study of infants with bronchiolitis requiring admission to PICU. Demographic, comorbidities, clinical data, respiratory support and adjuvant therapies were registered. Data expressed as median (IQR) or Percentage (range)
1147 patients were admitted with acute respiratory failure during study period. 871 younger than 2 years old, 467 diagnosed with community acquired bronchiolitis (range between centers 7.4–84%). 62.5% were male, median 4 (1.8,7.5) mo, 6.4kg (4.6,8.5), PIM3 score 0.29%(0.17,0.57). RSV etiology 67%, 1 patient died. Antibiotic use was frequent 55.9%(30,100) p=0.42. There was high heterogeneity between centers with significant differences on maximum respiratory support [HFNC 48.3%(4.4,88); BIPAP 25.6%(0,93); Invasive MV 16.75%(0,100)], bronchodilators [78.4%(0,100)] and steroids [30%(0,100)] use (all p<0.05). Among respiratory treatments, salbutamol use was 70.6% (16%,100), Nebulized Adrenaline 23% (0,40) and Ipratropium 10.4%(0,100) (all p<0.05). PICU LOS was 4.5 days (3.8,7.9), with significant differences between centers.
Significant variation on respiratory support approaches and bronchodilator therapies were observed across centers. Variability was not explained by disparities in population characteristics. Despite bronchiolitis is the leading cause of acute respiratory failure in infants there was a wide variation of its frequency between centers. Variability in the management of bronchiolitis between PICUs should trigger collaborative research initiatives, aiming to avoid gaps in knowledge and over and underuse of practices in order to improve health care performance.