Differences of Medical Care for Acute Severe Viral Bronchiolitis in Two Urban Areas in Europe

Abstract

Background Acute viral bronchiolitis is a frequent disease in infancy. There is little knowledge on medical care of severely affected infants in different European countries.

Patients: Infants (n=146) with bronchiolitis requiring respiratory support in winter season 2015/2016 treated in either one of two regions in Central Europe: South of greater Paris region in France (group 1) and Ruhr area in Germany (group 2).

Methods Retrospective chart review. Primary outcome parameter was duration of respiratory support.

Results Infants in group 1 (n=96) were younger, suffered less frequently from neurologic disorders and had lower respiratory rates than in group 2 (n=50). CO2 levels and dyspnea score were similar. Ninety percent of infants in group 1 were treated by nasal Continuous Airway Pressure CPAP, while 80% of infants in group 2 were treated by High Flow Nasal Cannula HFNC. Duration of respiratory support was significantly shorter in group 1. Infants in group 2 received more frequently infusion therapy, more antibiotics and more inhalation therapy.

Discussion Our results show better outcome for infants with viral bronchiolitis treated in France. Striking differences were the practice of respiratory support (nasal CPAP vs. HFNC) and the prescription of supportive treatments.

Conclusion Treatment approaches in severe acute viral bronchiolitis differ widely between a French and a German urban region.

Zusammenfassung

Hintergrund Die akute virale Bronchiolitis ist eine häufige Erkrankung im Säuglingsalter. Es existieren wenige Erkenntnisse über die Behandlung schwer erkrankter Kinder in unterschiedlichen europäischen Ländern.

Patienten Säuglinge (n=146) mit Bronchiolitis und mechanischer Atemunterstützung der Winter-Saison 2015/2016, die in einer der zwei teilnehmenden Regionen behandelt wurden: Süden des Großraums Paris in Frankreich (Gruppe 1) oder Ruhrgebiet in Deutschland (Gruppe 2).

Methoden Retrospektive Daten-Auswertung. Das primäre Ziel-Kriterium war die Dauer der Atemwegsunterstützung.

Ergebnisse Die Säuglinge in Gruppe 1 (n=96) waren jünger, hatten seltener neurologische Grunderkrankungen und eine niedrigere Atemfrequenz als in Gruppe 2 (n=50). CO2-Werte und Dyspnoe-Score unterschieden sich nicht. Neunzig Prozent der Säuglinge in Gruppe 1 wurden mit nCPAP (nasal Continuous Airway Pressure) behandelt, während 80% in Gruppe 2 HFNC (High Flow Nasal Cannula) erhielten. Die Dauer der Atemunterstützung war signifikant kürzer in Gruppe 1. Hingegen erhielten Säuglinge in Gruppe 2 häufiger Infusionstherapie, mehr Antibiotika und häufiger Inhalationen.

Diskussion Diese Ergebnisse zeigen ein besseres Outcome für Säuglinge, die in Frankreich behandelt wurden. Ein frappierender Unterschied zeigte sich in der Wahl der Atemunterstützung.

Schlussfolgerung Die Behandlung der schweren akuten viralen Bronchiolitis in Frankreich (Großraum Paris) unterscheidet sich deutlich von der in Deutschland (Ruhrgebiet).

Key words

viral bronchiolitis - nasal Continuous Airway Pressure - High Flow Nasal Cannula - antibiotic therapy

Schlüsselwörter

virale Bronchiolitis - nasales CPAP - High flow Nasal Cannula - antibiotische Therapie

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