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Milési C, Baudin F, Durand P, Emeriaud G, Essouri S, Pouyau R, Baleine J, Beldjilali S, Bordessoule A, Breinig S, Demaret P, Desprez P, Gaillard-Leroux B, Guichoux J, Guilbert AS, Guillot C, Jean S, Levy M, Noizet-Yverneau O, Rambaud J, Recher M, Reynaud S, Valla F, Radoui K, Faure MA, Ferraro G, Mortamet G. Clinical practice guidelines: management of severe bronchiolitis in infants under 12 months old admitted to a pediatric critical care unit. Intensive Care Med 2023; 49:5-25. [PMID: 36592200 DOI: 10.1007/s00134-022-06918-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/13/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE We present guidelines for the management of infants under 12 months of age with severe bronchiolitis with the aim of creating a series of pragmatic recommendations for a patient subgroup that is poorly individualized in national and international guidelines. METHODS Twenty-five French-speaking experts, all members of the Groupe Francophone de Réanimation et Urgence Pédiatriques (French-speaking group of paediatric intensive and emergency care; GFRUP) (Algeria, Belgium, Canada, France, Switzerland), collaborated from 2021 to 2022 through teleconferences and face-to-face meetings. The guidelines cover five areas: (1) criteria for admission to a pediatric critical care unit, (2) environment and monitoring, (3) feeding and hydration, (4) ventilatory support and (5) adjuvant therapies. The questions were written in the Patient-Intervention-Comparison-Outcome (PICO) format. An extensive Anglophone and Francophone literature search indexed in the MEDLINE database via PubMed, Web of Science, Cochrane and Embase was performed using pre-established keywords. The texts were analyzed and classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. When this method did not apply, an expert opinion was given. Each of these recommendations was voted on by all the experts according to the Delphi methodology. RESULTS This group proposes 40 recommendations. The GRADE methodology could be applied for 17 of them (3 strong, 14 conditional) and an expert opinion was given for the remaining 23. All received strong approval during the first round of voting. CONCLUSION These guidelines cover the different aspects in the management of severe bronchiolitis in infants admitted to pediatric critical care units. Compared to the different ways to manage patients with severe bronchiolitis described in the literature, our original work proposes an overall less invasive approach in terms of monitoring and treatment.
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Affiliation(s)
- Christophe Milési
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France.
| | - Florent Baudin
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Philippe Durand
- Pediatric Intensive Care Unit, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Kremlin-Bicêtre, France
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, Sainte-Justine University Hospital, Montreal, Canada
| | - Sandrine Essouri
- Pediatric Department, Sainte-Justine University Hospital, Montreal, Canada
| | - Robin Pouyau
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Julien Baleine
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Sophie Beldjilali
- Pediatric Intensive Care Unit, La Timone University Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Alice Bordessoule
- Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
| | - Sophie Breinig
- Pediatric Intensive Care Unit, Toulouse University Hospital, Toulouse, France
| | - Pierre Demaret
- Intensive Care Unit, Liège University Hospital, Liège, Belgium
| | - Philippe Desprez
- Pediatric Intensive Care Unit, Point-à-Pitre University Hospital, Point-à-Pitre, France
| | | | - Julie Guichoux
- Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - Anne-Sophie Guilbert
- Pediatric Intensive Care Unit, Strasbourg University Hospital, Strasbourg, France
| | - Camille Guillot
- Pediatric Intensive Care Unit, Lille University Hospital, Lille, France
| | - Sandrine Jean
- Pediatric Intensive Care Unit, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Michael Levy
- Pediatric Intensive Care Unit, Robert Debré Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Jérôme Rambaud
- Pediatric Intensive Care Unit, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Morgan Recher
- Pediatric Intensive Care Unit, Lille University Hospital, Lille, France
| | - Stéphanie Reynaud
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Fréderic Valla
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Karim Radoui
- Pneumology EHS Pediatric Department, Faculté de Médecine d'Oran, Canastel, Oran, Algeria
| | | | - Guillaume Ferraro
- Pediatric Emergency Department, Nice University Hospital, Nice, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
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Milani GP, Rocchi A, Teatini T, Bianchetti MG, Amelio G, Mirra N, Grava A, Agostoni C, Fossali EF. Hyponatremia in infants with new onset moderate-severe bronchiolitis: A cross-sectional study. Respir Med 2017; 133:48-50. [PMID: 29173449 DOI: 10.1016/j.rmed.2017.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 10/12/2017] [Accepted: 10/31/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The reported cumulative prevalence of hyponatremia (sodium <135 mmol/L) in bronchiolitis is 28%. However, sodium level was never measured by direct potentiometry, the method recommended by the International Federation of Clinical Chemistry and Laboratory Medicine. Aim of this study was to assess the prevalence of hyponatremia, measured by direct potentiometry, in infants with moderate-severe bronchiolitis. METHODS A prospective cross-sectional study was conducted in infants ≥1month and ≤24months of age with bronchiolitis. RESULTS 160 consecutive infants were enrolled. Hyponatremia was observed in 91 (57%) patients and occurred more commonly in infants ≤6 months than in older infant (P < 0.005). CONCLUSION The first study on sodium level measured by the direct potentiometry in infants with bronchiolitis points out that the prevalence of hyponatremia is two-fold higher than so far reported.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Alessia Rocchi
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Thomas Teatini
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario G Bianchetti
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Amelio
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nadia Mirra
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Grava
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Emilio F Fossali
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Moritz ML, Ayus JC. How to Improve Maintenance Intravenous Fluid Prescribing Practices in Bronchiolitis. Hosp Pediatr 2017; 7:300-302. [PMID: 28408387 DOI: 10.1542/hpeds.2017-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Michael L Moritz
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, The University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
| | - Juan C Ayus
- Renal Consultants of Houston, Houston, Texas
- Hospital Italiano, Universidad Austral, Buenos Aires, Argentina; and
- University of California Irvine School of Medicine, Irvine, California
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Al Shibli A, Abukhater D, Al Kuwaiti N, Noureddin MB, Al Harbi M, Al Kaabi A, Al Kaabi S, Hamie M, Al Amri A, Narchi H. Hyponatraemia and neurological complications in children admitted with bronchiolitis. Paediatr Int Child Health 2016; 36:175-80. [PMID: 27079908 DOI: 10.1080/20469047.2016.1162390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hyponatraemia occurs during bronchiolitis, sometimes with neurological manifestations. The prevalence of the latter differs widely and little is known about the time of occurrence and associated factors. This study was undertaken to investigate these complications. METHODS This was a retrospective observational chart review of a cohort of 233 infants under 2 years of age admitted with bronchiolitis to a teaching hospital in the United Arab Emirates. RESULTS Hyponatraemia (serum sodium <135 mmol/L) occurred in 105 infants (45%, 95% CI 38-51). Hyponatraemia was present on admission in 84 infants (80%) with 90% of cases occurring within 6 days of the onset of illness. It was mild (130-135) in 100 infants (95%) and severe (<130) in five (5%). It was not significantly associated with age, duration of illness before admission, viral aetiology, white cell count or serum C-reactive protein concentrations, or the volume of administered intravenous fluid or use of 0.18% sodium chloride (NaCl). Neurological manifestations occurred in a 29-day-old child with a serum sodium level of 123 mmol/L while receiving two-thirds intravenous maintenance fluids (0.18% NaCl). His developmental milestones remained normal on follow-up to the age of 5 years. CONCLUSION Hyponatraemia is common in infants with bronchiolitis and occurs in the majority within 6 days of onset of symptoms. There was a significant association between the presence of fever (>38°C) on admission and the duration of hospitalisation.
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Affiliation(s)
| | | | | | | | | | | | | | - May Hamie
- a Department of Pediatrics , Tawam Hospital , Al Ain
| | | | - Hassib Narchi
- b Department of Pediatrics , College of Medicine and Health Sciences, United Arab Emirates University , Al Ain , United Arab Emirates
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