Predictors of Admission of Patients with Bronchiolitis to the Intensive Care Unit (ICU)
Journal Title: Journal of Medical Science And clinical Research - Year 2014, Vol 2, Issue 8
Abstract
Background Bronchiolitis is a lower respiratory tract infection that occurs in children younger than two years old. It is usually caused by a virus; Bronchiolitis is a common cause of illness and is the leading cause of hospitalization in infants and young children. Bronchiolitis diagnosed clinically and can be treated by adequate fluids and oxygen therapy, but it can cause serious illness in some children and need Intensive Care Units management. Objectives To know the predictors of admission of the patient with bronchiolitis to the Intensive Care Unit.. Methods A prospective, cohort study was conducted during the period from November 2011 to March of 2012 in Babylon Gynecology and Children Teaching Hospital. All our patients (251) aged less than 2 years and diagnosed as bronchiolitis according to the American Academy Of Pediatrics definition were enrolled in the study. Regular ward admission and ICU admission were compared. Results Two hundred fifty one patients were studied, 215 (85.7%) were admitted in regular ward and 36 (14.3%)patients were admitted in Intensive Care Unit(ICU) .Emergency department predictors of ICU admission were age less than 3 months(mean 3.15±2.5 VS 4.8±4.5: P value 0.002), formula feeding(36% VS 13% :P value 0.005), low oxygen saturation SPO2 (83.2%±7.3 VS 92.1%±4.5 :p value 0.000), rapid respiratory rate(64.3±7 VS 55.07±8.1 breaths/min :P value 0.000), and inadequate oral intake(97% VS 59% P value 0.000). Other factors like family history of asthma, eczema, sex, breast feeding, birth weight, heart rate and chest x rays finding were not associated with ICU admission. Dr.Adnan Handhil Tarish JMSCR Volume 2 Issue 8 August 2014 Page 1980 JMSCR Volume||2||Issue||8||Page 1979-1985||August-2014 2014 INTRODUCTION Bronchiolitis is the most common lower respiratory tract infection in children younger than 2 years (Subcommittee on diagnosis and management of bronchiolitis: (2006), and present with wide a spectrum of clinical illness, from mild to severe symptoms of lifethreatening respiratory distress. Bronchiolitis is diagnosed clinically , and usually start with two or three days prodromal phase of coryzal symptoms, cough , tachypnea, dyspnea, wheeze, crackles, and low grade fever, In the 1st 72 hours of illness infant may get worse before starting to improve(Scottish Intercollegiate Guidelines Network. (2006) . and generally occurs in seasonal pattern, with the highest incidence in winter months (Bush A, Thomason AH. Acute bronchiolitis .BMJ.2007).The American Academy of Pediatrics (AAP) position paper in 2006, described the child with bronchiolitis as being below 2 years of age and having: rhinitis, tachypnea, wheezing, cough, crackles, uses accessory muscles, and/or nasal flaring (Subcommittee on diagnosis and management of bronchiolitis: (2006). A variety of causative agents have been identified, with respiratory syncytial virus (RSV) is the most common (50%)to (80%)(Joseph J. Zarc and Caraline Breese Hall. (2010) . Most children are infected with RSV by the age of 2 years(Glaen WP, Taber LH, Frank AL, Kasel JA, (1986). Other viruses have been linked to the bronchiolitis including Adenovirus(Rachall C, Gerben K, Daly J. (2004) ,Parainfuenza virus, influenza virus AB (Iwane MK, Edwards's km, Szilagyi PG. (2004), and Human metapneumovirus and Rhinovirus (Van den Haogen BG, et al. (2001).Corona virus also has been linked to lower respiratory tract diseases in children(Lan SK, Waa PC, Yip CC. (2006) .The decision whether bronchiolitis should be treated in hospital or in the community is a difficult one .A significant proportion of children with bronchiolitis are admitted in the hospital and the cause of admission varies across individual clinician and institution (Chamberlain JM, Patel KM, Pollack MM, (2006) . Increased rate of bronchiolitis and increased hospitalization have been associated with house crowding( Fiqueras-Aloy J, Carbonell-Estrony X, Q Uero J. (2004) , child care attendance (Simoes EA. (2003), maternal smoking during pregnancy(Carroll K, et al., (2007), passive smoking exposure(Stensballe LG, et al. (2006) , family asthma and child asthma and atopy (Carroll K, et al., (2007) . , (Stensballe LG, et al. (2006) , in addition to chronic medical condition including chronic lung disease (Glezen WP, et al: (2000) , congenital heart disease(Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection.(2003) , immune compromised child(Meissen HC. (2003) , low birth weight and prematurity have been associated with severe bronchiolitis(Holman RC, Shay DK, Curns AT, Lingappa JR, Anderson LJ. (2003) . An understanding of the possible etiology and risk factors for severe disease is likely to be important to the pediatrician who tries to make a decision about hospital admission and the level of care required for children who are admitted (Nielsen HE, etal. (2003) . Despite the increase in frequency of bronchiolitis, there is considerable variation in the usual care given these patients in the hospital (DorothyDamoreMD,et al(2008).Differences in patient severity undoubtedly contribute to this variability , but the primary cause may be simple ; practice preference ; that are pediatrician or institutionally determined and reflect the lack of consensus regarding optimal care( Everrad ML: (1995) .Treatment when needed, is supportive in order to maintain adequate hydration and oxygenation( Lazano JM, Wang E. (2002) . Patients in whom need for admission to intensive care Conclusion Age of less than 3 months, formula feeding, low oxygen saturation SPO2 (83%), rapid respiratory rate, and inadequate oral intake are all predictors of ICU admission in children with bronchiolitis
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Dr. Adnan Handhil Tarish
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