title: A regional cohort study of the treatment of critically ill children with bronchiolitis.
abstract: To describe the treatment practices in critically ill children with RSV bronchiolitis across four regional PICUs in the northeastern United States, and to determine the factors associated with increased ICU length of stay in this population.
  
  
  
  We conducted a retrospective cohort study of children who were admitted with RSV bronchiolitis between July 2009 and July 2011 to the PICUs of Connecticut Children's Medical Center, Yale-New Haven Children's Hospital, Maria Fareri Children's Hospital, and Baystate Children's Hospital. Data were collected regarding clinical characteristics and intensive care course among these hospitals.
  
  
  
  During the study period, 323 children were admitted to one of the four ICUs with RSV bronchiolitis. Despite similar mortality risk scores among ICUs, there was considerable variation in the use of therapies, particularly intubation and mechanical ventilation, in which there was greater than a 3.5-fold increased risk of intubation between sites with the highest and lowest frequency of intubation (odds ratio: 3.8; 95% confidence interval: 2.2-6.4). Albuterol was the most commonly used respiratory treatment, followed by chest physiotherapy, high-flow nasal cannula, and hypertonic saline. Longer stays in the ICU were associated with more frequent use of therapies, specifically invasive mechanical ventilation, inhaled corticosteroids, intrapulmonary percussive ventilation, and chest physiotherapy.
  
  
  
  Even within a close geographic region, there is significant variation in the treatment provided to critically ill children with RSV bronchiolitis. None of these treatments were associated with shorter durations of hospitalization in this population and some, such as mechanical ventilation, were associated with longer ICU lengths of stay.
authors.affiliation: a Connecticut Children's Medical Center , Hartford , CT , USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Carroll
authors.affiliation: b Yale University School of Medicine , New Haven , CT , USA.
authors.forename: Edward Vincent S
authors.initials: EV
authors.lastname: Faustino
authors.affiliation: c Maria Fareri Children's Hospital at Westchester Medical Center , Valhalla , NY , USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Pinto
authors.affiliation: a Connecticut Children's Medical Center , Hartford , CT , USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Sala
authors.affiliation: b Yale University School of Medicine , New Haven , CT , USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Canarie
authors.affiliation: c Maria Fareri Children's Hospital at Westchester Medical Center , Valhalla , NY , USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Li
authors.affiliation: b Yale University School of Medicine , New Haven , CT , USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Giuliano
authors.affiliation: d New Haven , CT , USA.
authors.lastname: The Northeast Pediatric Critical Care Research Consortium
mesh_terms: D000420:Albuterol / Q000627:therapeutic use; D001988:Bronchiolitis / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016638:Critical Illness; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D009511:New England / Q000453:epidemiology; D012121:Respiration, Artificial; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol
keywords: Respiratory syncytial virus; critical care; intensive care unit; pediatrics; respiratory failure