Determinants of invasive ventilation in infants with acute bronchiolitis: an observational study of pre-hospital and in-hospital treatments.

OBJECTIVE

To analyze the factors associated with invasive ventilation in infants admitted to the hospital with acute bronchiolitis and identify the treatments administered before and during hospitalization.

METHODS

This single-center observational retrospective study included 266 infants with acute bronchiolitis who were admitted to the pediatric ward of a university hospital in São Paulo between January 2020 and March 2023. Multivariate logistic regression analysis was used to investigate the factors associated with invasive ventilation, and Prais-Winsten regression was used to analyze the temporal trends of cases. Statistical significance was set at p<0.05.

RESULTS

Of 266 participants, 16 (6%) were intubated. The multivariate analysis revealed that younger age (adjusted odds ratio (AOR)=0.71; 95% confidence interval (95%CI)=0.53-0.96; p=0.02), higher Wood-Downes-Ferres scores at admission (AOR=2.02; 95%CI=1.03-3.95; p=0.03), and the presence of atelectasis on radiography (AOR=26.4; 95%CI=3.85-182.18; p=0.001) were associated with invasive ventilation. Increased bronchodilator use (30.0% versus 79.7%, p<0.001) and decreased corticosteroid use (27.8% versus 25.5%, p=0.004) were observed before and after admission, respectively. Temporal analysis revealed a stationary trend (p=0.41).

CONCLUSION

In infants with acute bronchiolitis, younger age, presence of atelectasis, and higher Wood-Dowes-Ferres scores at admission were associated with invasive ventilation. Medications were frequently administered to the patients before and during hospitalization. This study emphasizes the need to consider these factors when caring for these infants and for clinical protocols to reduce the use of medications before and during hospitalization.