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Management of Hospitalized Respiratory Syncytial Virus Bronchiolitis in the Pediatric Ward in Spain: Assessing the Impact of a New Clinical Practice Protocol
Pediatric Drugs ( IF 3.7 ) Pub Date : 2021-12-22 , DOI: 10.1007/s40272-021-00488-6
Jorgina Vila 1, 2 , Esther Lera 2, 3 , Paula Peremiquel-Trillas 4, 5 , Laia Martínez 6 , Irene Barceló 6 , Cristina Andrés 7 , José Ángel Rodrigo-Pendás 4 , Andrés Antón 7 , Carlos Rodrigo 2, 8, 9
Affiliation  

Background

Bronchiolitis caused by the respiratory syncytial virus (RSV) is the main reason for hospitalization in infants. Supportive care is the mainstay of treatment, and tests are restricted to a few indications. During 2015, our hospital bronchiolitis protocol (2015 HBP) was updated according to the latest practice guidelines.

Objective

The objective of this study was to assess implementation of the 2015 HBP and the clinical outcome of children aged ≤ 24 months with RSV bronchiolitis admitted to a pediatric ward.

Methods

We compared the use of treatments and tests, hospital length of stay (LOS), and oxygen requirements before implementation of the 2015 HBP (2014–2015 and 2015–2016 seasons) and after implementation (2016–2017 and 2017–2018 seasons).

Results

The study population comprised 251 children (44.90%) in the first period and 308 (55.10%) in the second (median age 99 days, interquartile range 44–233). After implementation of the 2015 HBP, a statistically significant reduction was found in the percentage of patients undergoing the following treatments or diagnostic tests: salbutamol, from 57.77 to 31.17% (p < 0.001); epinephrine, from 61.75 to 1.30% (p < 0.001); 3% hypertonic saline, from 70.12 to 6.82% (p < 0.001); antibiotics, from 33.07 to 23.05% (p = 0.008); and chest X-ray, from 43.82 to 31.17% (p = 0.001). No statistically significant reductions were observed in the use of corticosteroids and blood tests. Hospital LOS and oxygen requirements were similar in each period.

Conclusions

Appropriate implementation of the 2015 HBP in the pediatric ward improves the use of medication and chest X-ray without modifying clinical outcomes. However, further efforts are needed to reduce the use of salbutamol, corticosteroids, and blood tests.



中文翻译:

西班牙儿科病房住院呼吸道合胞病毒性细支气管炎的管理:评估新临床实践方案的影响

背景

由呼吸道合胞病毒(RSV)引起的细支气管炎是婴儿住院的主要原因。支持性护理是治疗的主要手段,测试仅限于少数适应症。2015 年,我们的医院毛细支气管炎方案 (2015 HBP) 根据最新的实践指南进行了更新。

客观的

本研究的目的是评估 2015 年 HBP 的实施情况以及入住儿科病房的 ≤ 24 个月的 RSV 细支气管炎儿童的临床结果。

方法

我们比较了 2015 年 HBP(2014-2015 和 2015-2016 季节)实施前和实施后(2016-2017 和 2017-2018 季节)的治疗和测试使用、住院时间 (LOS) 和氧气需求。

结果

研究人群包括第一阶段的 251 名儿童(44.90%)和第二阶段的 308 名儿童(55.10%)(中位年龄 99 天,四分位距 44-233)。实施 2015 年 HBP 后,接受以下治疗或诊断测试的患者百分比显着降低:沙丁胺醇,从 57.77% 降至 31.17%(p < 0.001);肾上腺素,从 61.75 到 1.30% ( p < 0.001);3% 高渗盐水,从 70.12 到 6.82% ( p < 0.001);抗生素,从 33.07% 到 23.05% ( p = 0.008);和胸部 X 光片,从 43.82% 到 31.17% ( p= 0.001)。在使用皮质类固醇和验血方面没有观察到统计学上的显着减少。每个时期的医院 LOS 和氧气需求相似。

结论

在儿科病房适当实施 2015 年 HBP 可改善药物和胸部 X 光片的使用,而不会改变临床结果。然而,需要进一步努力减少沙丁胺醇、皮质类固醇和血液检查的使用。

更新日期:2021-12-22
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