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