Oakley Ed, Chong Vi, Borland Meredith, Neutze Jocelyn, Phillips Natalie, Krieser David, Dalziel Stuart, Davidson Andrew, Donath Susan, Jachno Kim, South Mike, Fry Amanda, Babl Franz E
Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Emerg Med Australas. 2017 Aug;29(4):421-428. doi: 10.1111/1742-6723.12778. Epub 2017 May 19.
To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis.
Retrospective review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2-12 months old admitted with bronchiolitis.
Seven Australian and New Zealand hospitals. These infants were prospectively identified through the comparative rehydration in bronchiolitis (CRIB) study between 2009 and 2011.
Of 3884 infants identified, 3589 charts were available for analysis. Of 204 (5.7%) infants with bronchiolitis admitted to ICU, 162 (79.4%) received ventilation support. Of those 133 (82.1%) received non-invasive ventilation (high flow nasal cannula [HFNC] or continuous positive airway pressure [CPAP]) 7 (4.3%) received invasive ventilation alone and 21 (13.6%) received a combination of ventilation modes. Infants with comorbidities such as chronic lung disease (OR 1.6 [95% CI 1.0-2.6]), congenital heart disease (OR 2.3 [1.5-3.5]), neurological disease (OR 2.2 [1.2-4.1]) or prematurity (OR 1.5 [1.0-2.1]), and infants 2-6 months of age (OR 1.5 [1.1-2.0]) were more likely to be admitted to ICU. Respiratory syncitial virus positivity did not increase the likelihood of being admitted to ICU (OR 1.1 [95% CI 0.8-1.4]). HFNC use changed from 13/53 (24.5% [95% CI 13.7-38.3]) patient episodes in 2009 to 39/91 (42.9% [95% CI 32.5-53.7]) patient episodes in 2011.
Admission to ICU is an uncommon occurrence in infants admitted with bronchiolitis, but more common in infants with comorbidities and prematurity. The majority are managed with non-invasive ventilation, with increasing use of HFNC.
描述毛细支气管炎婴儿入住重症监护病房（ICU）的比例、所提供的通气支持类型以及入住ICU的危险因素。
对2至12个月大因毛细支气管炎入院的婴儿的医院记录以及澳大利亚和新西兰儿科重症监护（ANZPIC）登记数据进行回顾性分析。
澳大利亚和新西兰的七家医院。这些婴儿是在2009年至2011年期间通过毛细支气管炎比较补液（CRIB）研究前瞻性确定的。
在确定的3884名婴儿中，有3589份病历可供分析。在204名（5.7%）因毛细支气管炎入住ICU的婴儿中，162名（79.4%）接受了通气支持。其中，133名（82.1%）接受无创通气（高流量鼻导管[HFNC]或持续气道正压通气[CPAP]），7名（4.3%）仅接受有创通气，21名（13.6%）接受通气模式的联合使用。患有慢性肺病（比值比[OR]1.6[95%置信区间（CI）1.0 - 2.6]）、先天性心脏病（OR 2.3[1.5 - 3.5]）、神经疾病（OR 2.2[1.2 - 4.1]）或早产（OR 1.5[1.0 - 2.1]）等合并症的婴儿，以及2至6个月大的婴儿（OR 1.5[1.1 - 2.0]）更有可能入住ICU。呼吸道合胞病毒阳性并未增加入住ICU的可能性（OR 1.1[95% CI 0.8 - 1.4]）。HFNC的使用从2009年的13/53（24.5%[95% CI 13.7 - 38.3]）例次增加到2011年的39/91（42.9%[95% CI 32.5 - 53.7]）例次。
因毛细支气管炎入院的婴儿入住ICU并不常见，但在患有合并症和早产的婴儿中更为常见。大多数婴儿采用无创通气治疗，且HFNC的使用越来越多。
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