Burden of disease and change in practice in critically ill infants with bronchiolitis in Australia and New Zealand 2002 to 2014

Abstract

Background and aims There are limited large-scale data reflecting changes in the burden of severe bronchiolitis in critically ill infants. We assessed the incidence, respiratory support therapy, outcomes, and costs of severe bronchiolitis in ICU over the past decade. Methods Observational multicenter study of all ICUs contributing to the Australia and New Zealand Paediatric Intensive Care Registry. Infants <24 months with bronchiolitis requiring admission to ICU 2002-2014 were included. Intubation was defined as the primary outcome. Results Bronchiolitis was responsible for 9,628 (27.6%) of 34,829 non-elective admissions. The population-based ICU admission rate due to bronchiolitis increased by 11.76/100,000 each year (95%-CI 8.11 to 15.41). The proportion of bronchiolitis patients receiving invasive ventilation decreased from 36.8% in 2002, to 10.8% in 2014 (adjusted OR 0.35; 0.27-0.46), whilst a dramatic increase in high-flow nasal cannula therapy (HFNC) use to 72.6% was observed (p<0.001). In an adjusted model, 60.9% of the variation in invasive ventilation was not explained by case mix or temporal trends, likely reflecting underlying differences in unit practice. Annual direct hospitalization costs increased from AU$11.4 M in 2002 to AU$44.3 M in 2014. Conclusions We observed a major change in practice in the management of severe bronchiolitis from invasive to non-invasive support including HFNC therapy. Our data suggest that thresholds to admit bronchiolitis patients to ICU have changed over the past decade with a major impact on healthcare-related costs and resource utilization in ICUs. Interventional trials addressing outcome benefit, risk stratification and safe management of bronchiolitis outside ICUs are urgently warranted.L6138857832017-01-02 <br />