Hospital Admissions After Standard Versus Positive Pressure Nebulization in Patients with Bronchiolitis

Abstract

In the United States, bronchiolitis has consistently been the most common diagnosis leading to hospitalization in infants under one year of age, representing over 90,000 cases a year and a significant financial burden on the healthcare system. A condition with such widespread incidence should have an established algorithm for treatment of respiratory symptoms, but studies on the efficacy of certain therapies have been inconclusive. Some reports suggest that the use of positive pressure nebulization may be of benefit in treating bronchiolitis, but it has not yet been studied systematically. 1) To determine whether positive pressure nebulization (PPN) is more effective than standard nebulization (SN) in reducing admission rate in infants with bronchiolitis 2) To determine whether the use of positive pressure nebulization causes a change in Bronchiolitis Score, Pediatric Intensive Care Unit (PICU) admission rate, length of stay (LOS), and unscheduled returns to the pediatric emergency department (PED). The project is a retrospective study conducted at a single‐center tertiary care children's hospital. Participants included in the study were infants 2‐24 months of age with moderate to severe bronchiolitis, who were evaluated by trained respiratory therapists using an objective scoring tool and treatment algorithm that included suctioning, albuterol, and racemic epinephrine. Infants received the above nebulization therapies by either a standard or a positive pressure nebulization delivery device. The two treatment groups were compared to see if one approach was superior as measured by outcomes such as hospital and PICU admission rate, length of stay, and returns to the emergency department. Initial survey of the 2012‐2013 winter season at Phoenix Children's Hospital yielded 2,095 patients who were diagnosed with bronchiolitis. As the majority of patients were excluded due to age, comorbidities, or poor documentation of treatment, our study examined 19 patients who received positive pressure nebulization, which were matched in a 1:3 ratio (PPN:SN), for a total of 57 patients who received standard nebulization. In measuring the primary markers of outcome, we found that 12 of the 19 PPN patients (63%) were admitted to the regular pediatric ward, and 4 of the 19 (21%) were admitted to the PICU. 35 of the 57 SN patients (63%) were admitted to the regular pediatric ward, and 5 of the 57 (8%) were admitted to the PICU. Statistical analysis showed that the estimated minimum 'n' required in each treatment group was 252 patients, but our study was only able to obtain a sample size of 19 patients in the PPN group, which was not enough for statistical significance. An association between hospital admission rate with positive pressure nebulization or standard nebulization was not able to be determined.