Critical Care Thresholds in Children with Bronchiolitis

Am J Perinatol 2020; 37: S42-S45 DOI: 10.1055/s-0040-1714373Reduction in mortality from bronchiolitis in developed health is principally achieved from the availability of critical care. Different health care providers and countries demonstrate considerable variance in admission rates, but globally the use and cost of this resource are increasing. The reasons of this are multifold and include organizational, cultural, and clinical aspects. The organization of care has evolved differently in different health care settings at the threshold of critical need, with local priorities and resources determining the location of care (ward or critical care). Critical care areas adopting high-flow oxygen therapy (HFOT) (a ward-based therapy in some institutions) have seen significant increase in their occupancy, without change in rates of mechanical ventilation. Culturally, some countries appear to have a lower threshold for intubation and mechanical ventilation: United States (18%), Finland (4%), and even in countries with high rates of critical care admission (27% in Australia and New Zealand), intubation rates can decline with time (reducing from 27% to 11%). Baseline clinical characteristics of children admitted to critical care are remarkably similar, children are young (c30–60 days) and often born prematurely (21–46%). Clinical thresholds for admission as predefined by critical care units in online guidance focus on presence of apnea (observed in 7–42% of admission...
Source: American Journal of Perinatology - Category: Perinatology & Neonatology Authors: Tags: Review Article Source Type: research

Related Links:

Source: Journal of Asthma and Allergy - Category: Allergy & Immunology Tags: Journal of Asthma and Allergy Source Type: research
AbstractIntroductionViral respiratory tract infections are the leading cause of acute wheezing in children with a significant risk of hospital admission, risk of recurrence and subsequent asthma. Human respiratory syncytial virus (RSV) and human rhinovirus (RV) in childhood wheezing are widely studied; however, accessible PCR assays enabled diagnosis of other pathogens, including bocavirus (hBOV) and metapneumovirus (hMPV).ObjectivesThe aim of the study was to evaluate the prevalence of respiratory viruses in children hospitalized for acute wheezing along with demographic and clinical data.MethodsWe enrolled 101 children,n...
Source: The Clinical Respiratory Journal - Category: Respiratory Medicine Authors: Tags: ORIGINAL ARTICLE Source Type: research
Authors: Schroter S, Thomas D, Nimmer M, Visotcky A, Fraser R, Colella MR, Browne LR Abstract Background: The prehospital care of asthma, bronchiolitis and croup is directed by evidence-based Emergency Medical Services (EMS) protocols. Determining the appropriate intervention for these conditions requires Emergency Medical Technicians-Paramedics (EMT-Ps) to correctly differentiate asthma/bronchospasm, bronchiolitis, and croup. The diagnostic accuracy of EMT-Ps for these pediatric respiratory distress conditions is unknown.Objective: We hypothesized increasing provider age, years of provider experience, higher volum...
Source: Prehospital Emergency Care - Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research
AbstractIntroductionViral respiratory tract infections are leading cause of acute wheezing in children with significant risk of hospital admission, risk of recurrence and subsequent asthma.Human respiratory syncytial virus (RSV) and human rhinovirus (RV) in childhood wheezing are widely studied, however, accessible PCR assays enabled diagnosis of other pathogens, including bocavirus (hBOV) and metapneumovirus (hMPV).ObjectivesThe aim of the study was to evaluate prevalence of respiratory viruses in children hospitalized for acute wheezing along with demographic and clinical data.MethodsWe enrolled 101 children, n=50 (49.5%...
Source: The Clinical Respiratory Journal - Category: Respiratory Medicine Authors: Tags: ORIGINAL ARTICLE Source Type: research
Conclusions Individually and collectively, RSQMs can distinguish variations in the tasks residents perform across patient encounters.
Source: Academic Medicine - Category: Universities & Medical Training Tags: Research Reports Source Type: research
This study explores the associations between resident-sensitive quality measures (RSQMs) and supervisor entrustment as well as between RSQMs and patient acuity and complexity for encounters in the pediatric emergency department (PED) in which residents are caring for patients. Method Pediatric residents rotating through Cincinnati Children’s Hospital Medical Center PED as well as supervising pediatric emergency medicine faculty and fellows were recruited during the 2017–2018 academic year for the purpose of collecting the following data from the residents’ patient encounters for 3 illnesses (acute asth...
Source: Academic Medicine - Category: Universities & Medical Training Tags: Research Reports Source Type: research
pps Acute viral bronchiolitis causes significant mortality in the developing world, is the number one cause of infant hospitalisation in the developed world, and is associated with the later development of chronic lung diseases such as asthma. A vaccine against respiratory syncytial virus (RSV), the leading cause of viral bronchiolitis in infancy, remains elusive, and hence new therapeutic modalities are needed to limit disease severity. However, much remains unknown about the underlying pathogenic mechanisms. Neutrophilic inflammation is the predominant phenotype observed in infants with both mild and severe disease, ...
Source: Viruses - Category: Virology Authors: Tags: Review Source Type: research
The objective was to determine whether high-flow nasal cannula (HFNC), a promising respiratory support in infant bronchiolitis, could reduce the proportion of treatment failure requiring escalation of care. Methods In this randomised controlled trial, we assigned infants aged
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Paediatric pulmonology Original Articles: Paediatrics Source Type: research
GB Abstract BACKGROUND: Acute respiratory illnesses cause substantial morbidity worldwide. Cough is a common symptom in these childhood respiratory illnesses but there is currently no large cohort data on whether various cough characteristics can differentiate between these aetiologies. RESEARCH QUESTION: Can various clinically-based cough characteristics (frequency [day-time/ night-time], the sound itself, or type [wet/dry]) be used to differentiate common aetiologies (asthma, bronchiolitis, pneumonia, other acute respiratory infections) of acute cough in children? STUDY DESIGN AND METHODS: Between 201...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
Conclusions: A diagnosis of HP should be considered in pediatric lung biopsies with granulomatous interstitial and peribronchial inflammation, if infectious etiologies are excluded. Integration of clinical, radiological, and laboratory findings can facilitate a timely diagnosis. PMID: 32619123 [PubMed - as supplied by publisher]
Source: Fetal and Pediatric Pathology - Category: Pathology Tags: Fetal Pediatr Pathol Source Type: research
More News: Asthma | Australia Health | Bronchiolitis | Children | Finland Health | Health Management | New Zealand Health | Perinatology & Neonatology | USA Health