28-Noninvasive Ventilation in Severe Bronchiolitis: Effects on Intubation Rates and Outcomes
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Pediatrics, Pulmonary, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Michael Salt


Introduction/Hypothesis: Bronchiolitis is the most common diagnosis in children <2 years old. Of those hospitalized, 6-16% require pediatric ICU (PICU) admission. While invasive modalities have historically been utilized for management, data suggest that non-invasive ventilation (NIV) can be effective and safe. One such modality, RAM cannula, can be used off-label to deliver noninvasive CPAP and BiPAP. However, there continues to be wide practice variability in the use of NIV for these patients. At Massachusetts General Hospital for Children, we are increasingly using BiPAP via RAM cannula as the maximum level of NIV prior to intubation. This study aims to characterize how changes in practice patterns have affected intubation rates and outcomes among patients with severe bronchiolitis.

Methods: A retrospective analysis was performed using Virtual Pediatric Systems (VPS). VPS was queried for patients at MGHfC with a diagnosis of bronchiolitis. All patients over 2 years old, or who had a prior tracheostomy were excluded. Patient characteristics and outcomes were obtained. Descriptive analyses were performed to assess trends in ventilator and RAM cannula utilization in context of their illness severity using PIM2 scores.

Results: 627 patients fitting criteria were treated in the PICU over 11 years. The severity of illness for all patients increased over this period with an average PIM2 score of -5.18 in 2020 vs. -6.09 in 2009. The trend in intubations decreased over this time, despite increasing severity of illness scores. Adopted in 2016, BiPAP via RAM cannula was initially used in 2% of patients as opposed to 75% of patients in 2020. In 2016, 13.6% required mechanical ventilation (MV), whereas only 4.4% required MV in 2020. Patients treated with BiPAP via RAM cannula had an average PIM2 score of -5.14, a hospital length of stay (LOS) of 6.84 days and an ICU stay of 4.98 days, compared to patients requiring MV who had PIM2 scores of -5.15, a hospital LOS of 13.36 days, and an ICU stay of 10.02 days.

Conclusions: RAM cannula is an effective treatment modality for patients with severe bronchiolitis. Increased utilization of this modality allowed patients to be treated with NIV, who historically may have required MV based on illness scores. Use of RAM cannula has decreased hospital and PICU length of stay.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Pulmonary
Knowledge Level Advanced
Membership Level Select
Tag Ventilation
Tag Airway Management
Tag Pediatrics
Year 2021
noninvasive ventilation
severe bronchiolitis
pediatric intensive care units
decreased intubation rates
biphasic ventilatory support


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