Use of bilevel positive pressure ventilation in patients with bronchiolitis

Rational This study aims at describing the use of bilevel positive airway pressure (BiPAP) in infants with severe bronchiolitis. Working Hypothesis The use of BiPAP in infants with bronchiolitis may be associated with a worst outcome. Study Design A single-center retrospective study performed from October 2013 to April 2016. Methodology All infants from 1 day to 6 months of age admitted in the pediatric intensive care unit (PICU) were included if they had a clinical diagnosis of bronchiolitis and if they required any type of noninvasive ventilation (NIV), including high flow nasal cannula, continuous positive airway pressure and BiPAP at admission in PICU. There was no local written protocol regarding the ventilator management during the study. Results Overall, 252 infants (median age 45 (26-72) days) were included in the study and 110 infants (44%) were supported by BiPAP at admission. More infants were born preterm in the group of patients supported by BiPAP at admission. No complication related to NIV occurred. Patients in the BiPAP group had a longer duration of noninvasive support as well as a longer PICU length of stay. However, hospital length of stay did not differ according to the type of respiratory support at admission. Conclusion The use of BiPAP was not associated with endotracheal intubation, however it was associated with increased PICU length of stay and increased duration of NIV.