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Suctioning and Length of Stay in Infants Hospitalized With Bronchiolitis

Grant M. Mussman, MD; Michelle W. Parker, MD; Angela Statile, MD; Heidi Sucharew, PhD; Patrick W. Brady, MD, MSc
JAMA Pediatr. 2013;167(5):414-421. doi:10.1001/jamapediatrics.2013.36.
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Importance Hospitalizations of infants for bronchiolitis are common and costly. Despite the high incidence and resource burden of bronchiolitis, the mainstay of treatment remains supportive care, which frequently includes nasal suctioning.

Objective To examine the association between suctioning device type and suctioning lapses greater than 4 hours within the first 24 hours after hospital admission on length of stay (LOS) in infants with bronchiolitis.

Design Retrospective cohort study. Data were extracted from the electronic health record.

Setting Main hospital and satellite facility of a large quaternary care children's hospital from January 10, 2010, through April 30, 2011.

Participants A total of 740 infants aged 2 to 12 months and hospitalized with bronchiolitis.

Main Outcome Measure Hospital LOS.

Results In the multivariable model adjusted for inverse weighting for propensity to receive deep suctioning, increased deep suction as a percentage of suction events was associated with increased LOS with a geometric mean of 1.75 days (95% CI, 1.56-1.95 days) in patients with no deep suction and 2.35 days (2.10-2.62 days) in patients with more than 60% deep suction. An increased number of suctioning lapses was also associated with increased LOS in a dose-dependent manner with a geometric mean of 1.62 days (95% CI, 1.43-1.83 days) in patients with no lapses and 2.64 days (2.30-3.04 days) in patients with 3 or 4 lapses.

Conclusions and Relevance For patients admitted with bronchiolitis, the use of deep suctioning in the first 24 hours after admission and lapses greater than 4 hours between suctioning events were associated with longer LOS.

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Figure 1. Study population of infants aged 2 to 12 months and hospitalized with bronchiolitis from January 10, 2010, through April 30, 2011. ED indicates emergency department; PICU, pediatric intensive care unit.

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Figure 2. Unadjusted length of stay (LOS) by exposure. Error bars indicate 95% CIs.

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