Improved clinical and economic outcomes in severe bronchiolitis with pre-emptive nCPAP ventilatory strategy

• DOI: 10.1007/s00134-013-3129-z
• Publication Date: 2013-10-24T16:56:20Z
• Authors: Sandrine Essouri; Marie Laurent; Laurent Chevret; Philippe Durand; Emmanuelle Ecochard; Vincent Gajdos; Denis Devictor; Pierre Tissières
• Keywords: Time Factors; Continuous Positive Airway Pressure; Original; Cost-Benefit Analysis; Infant; Kaplan-Meier Estimate; Length of Stay; Intensive Care Units, Pediatric; Respiration, Artificial; 3. Good health; 03 medical and health sciences; Outcome and Process Assessment, Health Care; 0302 clinical medicine; Acute Disease; Bronchiolitis; Humans; Retrospective Studies

Severe bronchiolitis is the leading cause of admission to the pediatric intensive care unit (PICU). Nasal continuous positive airway pressure (nCPAP) has become the primary respiratory support, replacing invasive mechanical ventilation (MV). Our objective was to evaluate the economic and clinical consequences following implementation of this respiratory strategy in our unit.This was a retrospective cohort analysis of 525 infants with bronchiolitis requiring respiratory support and successively treated during two distinct periods with invasive MV between 1996 and 2000, P1 (n = 193) and nCPAP between 2006 and 2010, P2 (n = 332). Costs were estimated using the hospital cost billing reports.Patients' baseline characteristics were similar between the two periods. P2 is associated with a significant decrease in the length of ventilation (LOV) (4.1 ± 3.5 versus 6.9 ± 4.6 days, p < 0.001), PICU length of stay (LOS) (6.2 ± 4.6 versus 9.7 ± 5.5 days, p < 0.001) and hospital LOS. nCPAP was independently associated with a shorter duration of ventilatory support than MV (hazard ratio 1.8, 95% CI 1.5-2.2, p < 0.001). nCPAP was also associated with a significant decrease in ventilation-associated complications, and less invasive management. The mean cost of acute viral bronchiolitis-related PICU hospitalizations was significantly decreased, from 17,451 to 11,205 € (p < 0.001). Implementation of nCPAP led to a reduction of the total annual cost of acute viral bronchiolitis hospitalizations of 715,000 €.nCPAP in severe bronchiolitis is associated with a significant improvement in patient management as shown by the reduction in invasive care, LOV, PICU LOS, hospital LOS, and economic burden.