PURPOSE: Bronchiolitis is a common cause of critical illness in children, accounting for a considerable proportion of hospital and intensive care unit (ICU) admissions during seasonal epidemics. Despite extensive research examining this disease, no specific treatments have been found to shorten length of hospital or ICU stay. The purpose of this study was to characterize factors associated with length of stay (LOS) in children requiring mechanical ventilation for severe bronchiolitis.
METHODS: We conducted an observational study of all children admitted to the ICU with bronchiolitis who were intubated and mechanically ventilated between December 2007 and February 2010. Within 72 hours of intubation, baseline measurements of pulmonary mechanics, including measurements of dynamic compliance, static compliance, and pulmonary resistance, were obtained using the interrupter technique on repeated consecutive breaths.
RESULTS: Fifty-four children with bronchiolitis were enrolled during the study period. The mean (± SD) age was 75 ± 99 days, the mean hospital LOS was 18.3 ± 13.3 days, the mean ICU LOS was 11.3 ± 6.4 days, and the mean duration of mechanical ventilation was 8.5 ± 3.5 days. Fifty percent (n=27) of the children were male, 81% (n=44) had public insurance, 80% (n=41) were Caucasian, and 39% (n=21) were Hispanic. Non-Hispanic children had significantly longer ICU LOS compared to Hispanics (12.8 ± 7.5 vs. 9.0 ± 3.1 days; p=0.01), as did children with a history of prematurity (15.1 ± 8.4 vs. 9.9 ± 4.8 days; p=0.03). Increased pulmonary resistance was associated with increased ICU LOS (p=0.02), however, dynamic and static compliance were not. In a multiple regression analysis, prematurity, non-Hispanic ethnicity, and increased pulmonary resistance remained statistically significant predictors of ICU LOS (p< 0.05).
CONCLUSION: Prematurity, non-Hispanic ethnicity, and increased pulmonary resistance are associated with increased ICU length of stay in this small sample of mechanically ventilated children with bronchiolitis.
CLINICAL IMPLICATIONS: Measurements of pulmonary mechanics and demographic characteristics may act as markers for increased length of hospitalization in children with bronchiolitis and respiratory failure.
DISCLOSURE: Christopher Carroll, No Financial Disclosure Information; No Product/Research Disclosure Information