title: Improved clinical and economic outcomes in severe bronchiolitis with pre-emptive nCPAP ventilatory strategy.
abstract: OBJECTIVE
  Severe bronchiolitis is the leading cause of admission to the pediatric intensive care unit (PICU). Nasal continuous positive airway pressure (nCPAP) has become the primary respiratory support, replacing invasive mechanical ventilation (MV). Our objective was to evaluate the economic and clinical consequences following implementation of this respiratory strategy in our unit.
  
  
  METHODS
  This was a retrospective cohort analysis of 525 infants with bronchiolitis requiring respiratory support and successively treated during two distinct periods with invasive MV between 1996 and 2000, P1 (n = 193) and nCPAP between 2006 and 2010, P2 (n = 332). Costs were estimated using the hospital cost billing reports.
  
  
  RESULTS
  Patients' baseline characteristics were similar between the two periods. P2 is associated with a significant decrease in the length of ventilation (LOV) (4.1 ± 3.5 versus 6.9 ± 4.6 days, p < 0.001), PICU length of stay (LOS) (6.2 ± 4.6 versus 9.7 ± 5.5 days, p < 0.001) and hospital LOS. nCPAP was independently associated with a shorter duration of ventilatory support than MV (hazard ratio 1.8, 95% CI 1.5-2.2, p < 0.001). nCPAP was also associated with a significant decrease in ventilation-associated complications, and less invasive management. The mean cost of acute viral bronchiolitis-related PICU hospitalizations was significantly decreased, from 17,451 to 11,205 € (p < 0.001). Implementation of nCPAP led to a reduction of the total annual cost of acute viral bronchiolitis hospitalizations of 715,000 €.
  
  
  CONCLUSIONS
  nCPAP in severe bronchiolitis is associated with a significant improvement in patient management as shown by the reduction in invasive care, LOV, PICU LOS, hospital LOS, and economic burden.
authors.affiliation: Service de réanimation pédiatrique, Pediatric Intensive Care Unit, Hôpitaux Universitaires Paris Sud, site Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France, sandrine.essouri@bct.aphp.fr.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Essouri
authors.forename: Marie
authors.initials: M
authors.lastname: Laurent
authors.forename: Laurent
authors.initials: L
authors.lastname: Chevret
authors.forename: Philippe
authors.initials: P
authors.lastname: Durand
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Ecochard
authors.forename: Vincent
authors.initials: V
authors.lastname: Gajdos
authors.forename: Denis
authors.initials: D
authors.lastname: Devictor
authors.forename: Pierre
authors.initials: P
authors.lastname: Tissières
mesh_terms: D000208:Acute Disease; D001988:Bronchiolitis / Q000191:economics / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000191:economics / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000191:economics; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors