Weaning from noninvasive ventilatory support in infants with severe bronchiolitis: An observational study - 28/03/23

Doi : 10.1016/j.arcped.2023.03.003

J. Cassibba ^a,^⁎ , C. Freycon ^a, J. Doutau ^b, I. Pin ^a, A. Bellier ^c, B. Fauroux ^d,^e, G. Mortamet ^f,^g
^a Pediatric Department, Grenoble Alpes University Hospital, Grenoble, France
^b Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
^c Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
^d Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
^e Université de Paris, VIFASOM, Paris, France
^f Inserm U1042 unit, Grenoble Alpes University, Grenoble, France
^g Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France

^⁎Corresponding author at: Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, 38000, Grenoble, France.Pediatric Intensive Care UnitGrenoble Alpes University HospitalGrenoble38000France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 28 March 2023
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Abstract

Background

The aim of the study was to analyze the weaning success, the type of weaning procedures, and weaning duration in consecutive infants hospitalized in a pediatric intensive care unit over a winter season.

Methods

A retrospective observational study was conducted in a pediatric intensive care unit in a tertiary center. Infants hospitalized for severe bronchiolitis were included and the weaning procedure from continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), or high-flow nasal cannula (HFNC) was analyzed.

Results

Data from 95 infants (median age, 47 days) were analyzed. On admission, 26 (27%), 46 (49%), and 23 (24%) infants were supported with CPAP, NIV, and HFNC, respectively. Weaning failed in one (4%), nine (20%), and one (4%) infants while supported with CPAP, NIV, or HFNC, respectively (p = 0.1). In infants supported with CPAP, CPAP was stopped directly in five patients (19%) while HFNC was used as an intermediate ventilatory support in 21 (81%). The duration of weaning was shorter for HFNC (17 h, [IQR: 0–26]) than for CPAP (24 h, [14–40]) and NIV (28 h, [19–49]) (p < 0.01).

Conclusions

The weaning phase corresponds to a large proportion of noninvasive ventilatory support duration in infants with bronchiolitis. The weaning procedure following a “step-down” strategy may lead to an increase in the duration of weaning.

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Keywords : Infant, Weaning, Critically ill children, Acute respiratory failure, Mechanical ventilation