In the midst of a pandemic, it seems funny to be discussing bronchiolitis other than to say, “where has it gone?” But the truth is, once we get SARs-CoV2 under control (and we will) and mitigation strategies relax, the viral bronchiolitis will return and again fill beds on pediatric floors and intensive care units. Pelletier et al (10.1542/peds.2020-039115) evaluated trends in bronchiolitis pediatric intensive care unit (PICU) admissions to help us understand how its management may be changing over time. The authors analyzed more than 200,000 admissions for bronchiolitis between 2010 and 2019 in 38 free-standing children’s hospitals. While they found no significant increase in overall bronchiolitis admissions over time, they found that PICU admissions increased, from 11.7% in 2010 to 24.5% in 2019. In addition, the use of non-invasive ventilation increased seven-fold, from 1.2% in 2010 to 9.5% in 2019, while use of invasive mechanical ventilation did not change significantly during that time.
So, what is going on to increase the number of PICU admissions and the use of non-invasive ventilation? We invited hospitalists and bronchiolitis experts Dr. Brian Alverson from Brown and Dr. Shawn Ralston from Johns Hopkins to share their thoughts in an accompanying commentary (10.1542/peds.2020-046276). They focus on the phenomenon of increasing use of high-flow nasal cannula (HFNC) oxygen therapy as perhaps playing a key role in having more children transferred to PICUs to get this therapy. Most notably, they note the lack of evidence for HFNC therapy despite its popularity and remind us of the costs involved with using HFNC especially in the PICU. We thank Pelletier et al for making us aware of the increasing use of PICUs for non-invasive ventilation of young children with bronchiolitis and thank Drs. Alverson and Ralston for reminding us that we should not be using treatments like HFNC for bronchiolitis just because we feel we need to “do something” despite the lack of strong evidence for HFNC.
