Efficacy of interventions for bronchiolitis in critically ill infants: a systematic review and meta-analysis.
BACKGROUND
Viral bronchiolitis is the leading cause of respiratory failure among infants in the United States. Currently, the mainstay of treatment is supportive care. The effectiveness of treatments used for mechanically ventilated infants with bronchiolitis is unclear.


OBJECTIVE
To evaluate the strength of the evidence supporting the use of currently available treatments for critically ill infants with bronchiolitis.


METHODS
We searched PubMed, citations of relevant articles, personal files, and conference proceedings, and we contacted experts in the field.


METHODS
Randomized, controlled trials evaluating any therapy for bronchiolitis that included children in an intensive care unit.


METHODS
Two reviewers independently extracted data and assessed methodologic quality.


RESULTS
A total of 2,319 citations were screened, and 16 randomized, controlled trials were included. There were three trials of surfactant, three of ribavirin, three of immune globulin, three of systemic corticosteroids, and one each of vitamin A, interferon, erythropoietin, and heliox. A meta-analysis of the three surfactant studies showed a strong trend toward a decrease in duration of mechanical ventilation of 2.58 days (95% confidence interval, -5.34 to 0.18 days; p =.07) and a significant decrease of 3.3 intensive care unit days (95% confidence interval, -6.38 to -0.23 days; p =.04). A meta-analysis of the three systemic corticosteroid studies showed no overall effect on duration of mechanical ventilation when all three trials were combined (-0.62 day; 95% confidence interval, -2.78 to 1.53 days; p =.57). We identified one published meta-analysis of three ribavirin studies showing a significant decrease in ventilator days with ribavirin (-1.2 days; 95% confidence interval, -0.2 to -3.4 days; p =.2).


CONCLUSIONS
Currently, there are no clearly effective interventions available to improve the outcome of critically ill infants with bronchiolitis. Surfactant seems to be a promising intervention, and corticosteroids or ribavirin may also be beneficial.
Department of Anaesthesia, St. George's Hospital, Tooting, London, UK.
Caroline
C
Davison
Kathleen M
KM
Ventre
Marco
M
Luchetti
Adrienne G
AG
Randolph
D001988:Bronchiolitis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D016638:Critical Illness / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000517:prevention & control*; D018570:Risk Assessment; D013256:Steroids / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
D007136:Immunoglobulins; D011663:Pulmonary Surfactants; D013256:Steroids