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Impact of a nurse-driven noninvasive respiratory support discontinuation protocol in infants with severe bronchiolitis

Year: 2024

Type: article

Abstract: BACKGROUND: To evaluate a nurse-driven respiratory support discontinuation protocol in infants with bronchiolitis admitted in paediatric intensive care units. METHODS: A retrospective single-center study with pre-versus-post comparative design in a tertiary center. RESULTS: In total, 187 infants (95 with standard and 92 with nurse-driven protocols) were included. There was no difference in terms of weaning failure between the two periods (11 (12 %) versus 14 (15 %), p = 0.46). During the nurse-driven protocol period, discontinuation of the ventilatory support was performed later (at 44 hrs (IQR 29-67) versus 33 hrs (IQR 19-46), p = 0.001), but the weaning process duration was shorter than before protocol implementation (24 h (IQR 0-60) versus 39 (IQR 18-64), p = 0.01). The total duration of ventilation (excluding time on BiPAP) was similar before and after protocol (53 (IQR 37-81) versus 55 h (IQR 28-81), p = 0.46). The PICU and hospital lengths of stay did not differ between the two periods. CONCLUSIONS: In patients with bronchiolitis supported by noninvasive respiratory support, the nurse-driven discontinuation management - as opposed to physician-driven - was associated with a later discontinuation of the ventilatory support, while the weaning process duration was shorter than before protocol implementation.

Source: Archives de Pédiatrie

DOI: 10.1016/j.arcped.2024.08.006

Authors: Julie Cassibba, Marie Chevallier, Aurélie Alexandre, Alice Fumagalli, Brigitte Fauroux, Guillaume Mortamet