G496(P) Bronchiolitis high dependency management: the edinburgh experience

Background In our tertiary paediatric centre, ten percent of patients admitted with a diagnosis of bronchiolitis require high dependency (HDU) care. Our unit does not currently offer high frequency nasal cannulae oxygen (HFNCO2) on the wards, but plans to initiate this. Aims To complete a retrospective analysis of patients requiring escalation to HDU care, their management, length of stay and need for intensive care admission. Additionally, to assess the potential impact of introducing ward HFNCO2. Methods All admissions with bronchiolitis in infants under 14 months of age (n=509) from October 2016 to April 2017 were identified. There were 53 admissions to HDU; forty nine had complete electronic clinical records available to review. Results Table one shows the management strategies used, with 96% of patients commencing non-invasive respiratory support. A total of 10% of patients were subsequently admitted to paediatric intensive care, with 4% requiring intubation. There was similar frequency of use of CPAP and HFNCO2 as a first line treatment. Thirty-five percent were treated with HFNCO2 alone. When patients deteriorated despite non-invasive ventilation, rescue treatment with the other method was used. Of these ten cases (20%), only one subsequently required paediatric intensive care. Table 1 Conclusion Our centre currently uses HFNCO2 and CPAP in the HDU management of bronchiolitis. From this data, introducing ward HFNCO2 appears to have the potential to reduce over a third of HDU admissions. This data also supports the use of rescue treatment with the alternative mode of respiratory support to reduce admissions to our PICU.