• Mariana Miranda, Samiran Ray, Elizabeth Boot, David Inwald, Daleep Meena, Ramesh Kumar, Patrick Davies, Maria Rivero-Bosch, Philippa Sturgess, Charlotte Weeks, Kathryn Holliday, Sofia Cuevas-Asturias, Peter Donnelly, Ahmed Elsaoudi, Jon Lillie, Simon Nadel, Shane Tibby, and Rebecca Mitting.
• Pediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, United Kingdom.
• Pediatr Crit Care Me. 2023 Dec 1; 24 (12): 101010211010-1021.

ObjectivesManagement of mechanically ventilated patients with bronchiolitis is not standardized and duration of mechanical ventilation has been shown to vary widely between centers. The aim of this study was to examine practice in a large number of U.K. PICUs with a view to identify if early management choices relating to fluid prescription, sedative agent use, and endotracheal tube (ETT) placement were associated with differences in duration of invasive mechanical ventilation (IMV).DesignRetrospective multicenter cohort study. Primary outcome was duration of IMV. A hierarchical gamma generalized linear model was used to test for associations between practice variables (sedative and neuromuscular blocking agents, route of endotracheal intubation at 24 hr and fluid balance at 48 hr) and duration of IMV after adjustment for known confounders.SettingThirteen U.K. PICUs. Duration of 2 months between November and December 2019.PatientsThree hundred fifty infants receiving IMV for bronchiolitis. Excluded were patients receiving long-term ventilation, extracorporeal life support, or who died before separation from IMV.InterventionsNone.Measurements And Main ResultsAfter adjustment for confounders, several variables were associated with an increase in the geometric mean duration of IMV (expressed as a percentage) including: nasal ETT use, 16% (95% CI, 1-32%); neuromuscular blockade use, 39% (95% CI, 21-61%); and fluid balance at 48 hr, 13% per 100 mL/kg positive fluid balance (95% CI, -1% to 28%). The association of sedative use varied with class of agent. The use of an alpha-2 agonist alone was associated with a reduction in duration of IMV by 19% in relation to no sedative agent (95% CI, -31 to -5%), whereas benzodiazepine uses alone or with alpha-2 agonist in combination were similar to using neither agent.ConclusionsEarly management strategies for bronchiolitis were associated with the duration of IMV across U.K. centers after adjustment for confounders. Future work should prospectively assess the impact of fluid restriction, route of endotracheal intubation, and alpha-2 agonist use on duration of IMV in infants with bronchiolitis, with the aim of reducing seasonal bed pressure.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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