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Burden of disease and change in practice in critically ill infants with bronchiolitis

Luregn J. Schlapbach, Lahn Straney, Ben Gelbart, Janet Alexander, Donna Franklin, John Beca, Jennifer A. Whitty, Subodh Ganu, Barry Wilkins, Anthony Slater, Elizabeth Croston, Simon Erickson, Andreas Schibler on behalf of the Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE) and the Australian & New Zealand Intensive Care Society (ANZICS) Paediatric Study Group
European Respiratory Journal 2017 49: 1601648; DOI: 10.1183/13993003.01648-2016
Luregn J. Schlapbach
Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, AustraliaPaediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, AustraliaDept of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandL.J. Schlapbach and L. Straney contributed equally to this manuscript
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  • For correspondence: l.schlapbach@uq.edu.au
Lahn Straney
Dept of Epidemiology and Preventive Medicine, Monash University, Melbourne, AustraliaL.J. Schlapbach and L. Straney contributed equally to this manuscript
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Ben Gelbart
Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, AustraliaMelbourne Children's Research Institute, Melbourne, Australia
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Janet Alexander
Australian and New Zealand Paediatric Intensive Care Registry, CORE, Lady Cilento Children's Hospital Brisbane, Brisbane, AustraliaSchool of Medicine, The University of Queensland, Brisbane, Australia
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Donna Franklin
Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, Australia
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John Beca
Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
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Jennifer A. Whitty
School of Pharmacy, The University of Queensland, Brisbane, AustraliaHealth Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
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Subodh Ganu
University of Adelaide, Adelaide, AustraliaPaediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, Australia
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Barry Wilkins
Paediatric Intensive Care Unit, Children's Hospital Westmead, Sydney, Australia
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Anthony Slater
Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia
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Elizabeth Croston
Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Australia
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Simon Erickson
Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Australia
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Andreas Schibler
Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, AustraliaPaediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia
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Abstract

Bronchiolitis represents the most common cause of non-elective admission to paediatric intensive care units (ICUs).

We assessed changes in admission rate, respiratory support, and outcomes of infants <24 months with bronchiolitis admitted to ICU between 2002 and 2014 in Australia and New Zealand.

During the study period, bronchiolitis was responsible for 9628 (27.6%) of 34 829 non-elective ICU admissions. The estimated population-based ICU admission rate due to bronchiolitis increased by 11.76 per 100 000 each year (95% CI 8.11–15.41). The proportion of bronchiolitis patients requiring intubation decreased from 36.8% in 2002, to 10.8% in 2014 (adjusted OR 0.35, 95% CI 0.27–0.46), whilst a dramatic increase in high-flow nasal cannula therapy use to 72.6% was observed (p<0.001). We observed considerable variability in practice between units, with six-fold differences in risk-adjusted intubation rates that were not explained by ICU type, size, or major patient factors. Annual direct hospitalisation costs due to severe bronchiolitis increased to over USD30 million in 2014.

We observed an increasing healthcare burden due to severe bronchiolitis, with a major change in practice in the management from invasive to non-invasive support that suggests thresholds to admittance of bronchiolitis patients to ICU have changed. Future studies should assess strategies for management of bronchiolitis outside ICUs.

Abstract

Changing thresholds to admit bronchiolitis patients to PICU have had a major impact on cost and resource utilisation http://ow.ly/AVA630a08rx

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Support statement: The National Medical Health and Research Council (NHMRC) Australian Resuscitation Outcomes Consortium (Aus-ROC) Centre of Research Excellence, who funded Dr Straney, had no involvement in the design, analysis, and writing of the present manuscript. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Conflict of interest: None declared.

  • Received August 18, 2016.
  • Accepted March 3, 2017.
  • Copyright ©ERS 2017
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Burden of disease and change in practice in critically ill infants with bronchiolitis
Luregn J. Schlapbach, Lahn Straney, Ben Gelbart, Janet Alexander, Donna Franklin, John Beca, Jennifer A. Whitty, Subodh Ganu, Barry Wilkins, Anthony Slater, Elizabeth Croston, Simon Erickson, Andreas Schibler
European Respiratory Journal Jun 2017, 49 (6) 1601648; DOI: 10.1183/13993003.01648-2016

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Burden of disease and change in practice in critically ill infants with bronchiolitis
Luregn J. Schlapbach, Lahn Straney, Ben Gelbart, Janet Alexander, Donna Franklin, John Beca, Jennifer A. Whitty, Subodh Ganu, Barry Wilkins, Anthony Slater, Elizabeth Croston, Simon Erickson, Andreas Schibler
European Respiratory Journal Jun 2017, 49 (6) 1601648; DOI: 10.1183/13993003.01648-2016
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