RESULTS

A total of 73 children were included in the study from the two PICUs; mostly male (60.3%) and below six months old (56.2%), with a mean age of 7.2 months (SD 6.4 months).
Regarding nutritional status, the mean weight was 6.7 kg (SD 1.9 kg), with a mean Z-score of -0.35 (SD 1.5). Also, about 10% of children were classified as low weight-for-age. The mean gestational age was 37.5 weeks (SD 1.9 weeks), in which 18 (33.3%) children were premature, and the mean birth weight was 3 kg (SD 0.7 kg).
We observed that 45.2% of children were hospitalized at least once before this study. The most frequent causative agent was viral (75.3%), followed by bacterial (24.7%). More than 85% of children required nasal cannula oxygen therapy for 3.6 days (SD 3.5 days). Also, 15.10% of children required IMV for 6.2 days (SD 38.7 days), and 27.4% required NIV for 1.1 days (SD 2.7 days), mostly with a nasal prong (17.8%), biphasic positive airway pressure (BiPAP) mode (19.2%), and without sedation (86.3%). About 7% of children presented NIV failure, more than 4.0% required tracheostomy, and 84.9% required aspiration. Changes in decubitus were performed in 98.6% of children, and 1.4% adopted the prone position.
The most observed comorbidity was congenital heart disease (6.8%), and bronchopulmonary dysplasia, gastroesophageal reflux disease, complications, encephalopathy, and epilepsy presented the same frequency (2.7%). Regarding medications, the most used combination were antibiotics, hypertonic solution, salbutamol, and corticosteroids (31.5%), followed by steroids, salbutamol, and hypertonic solution (19.2%), and antibiotics, hypertonic solution, and albuterol (16.4%).
Frequent complications were ARF (45,21%), severe acute respiratory syndrome (SARS) (10,96%), pneumonia (4,11%), and SARS with pneumonia (2,74%). Also, 4.10% of children presented cardiopulmonary arrest and were submitted to resuscitation. The outcome for two children (2.70%) was death, most children (94.5%) were discharged to the ward, and two (2.7%) were discharged for home care. The mean hospitalization in PICU was 12 days (SD 39.8 days), and the mean total hospitalization was 15.7 days (SD 39.9 days).
Children under IMV presented lower weight than those without IMV (p = 0.019, Table 1). They also had a lower NIV use (p = 0.007) and death outcome (p = 0.021) and a higher frequency of SARS than children without IMV (p = 0.022, Table 2). In addition, the hospitalization period (PICU and total) was longer in children under IMV than those without IMV (p = 0.001, Table 2).
Most children under NIV also required IMV (p = 0.007) (Table 2). Also, children under NIV needed more aspiration than those without NIV (p = 0.021), and total hospitalization and in PICU were longer in children under NIV than those without NIV (p = 0.001, Table 2).
Children under IMV used nasal cannula (p = 0.005) and sedation with NIV more frequently than those without IMV (p = 0.001, Table 3). Also, they spent more days in NIV (p = 0.003), had a lower frequency of NIV in synchronized intermittent mandatory ventilation mode (p = 0.002), and higher frequency of NIV failure than children without IMV (p = 0.002, Table 3). Children under NIV spent more days in IMV than those without NIV (20.9 ± 73.0 versus 0.7 ± 2.8; p = 0.001).
Table 1. Sociodemographic, nutritional, and pregnancy-related characteristics of children with bronchiolitis under or without invasive or noninvasive mechanical ventilation hospitalized in PICU of a public emergency hospital