Temporal Changes in Prescription of Neuropharmacologic Drugs and Utilization of Resources Related to Neurologic Morbidity in Mechanically Ventilated Children With Bronchiolitis.

Published

Journal Article

OBJECTIVES: Critically ill children with bronchiolitis may require neuropharmacologic medications and support for neuro-functional sequelae, but current practices are not well described. We aimed to describe recent trends in neuropharmacology and utilization of neuro-rehabilitation resources in mechanically ventilated children with bronchiolitis. DESIGN: Analysis of the multicenter Pediatric Health Information System database. SETTING: Forty-seven U.S. children's hospitals. PATIENTS: PICU patients less than 2 years old with bronchiolitis undergoing mechanical ventilation between 2006 and 2015. INTERVENTIONS: None. Annual rates of utilization of neuropharmacologic medications (sedatives, analgesics, etc) and of neuro-rehabilitation services (physical therapy, neurologic consultation, etc) over the 10-year study period were compared. MEASUREMENTS AND MAIN RESULTS: Neuropharmacologic medications prescribed on greater than or equal to 2 days were extracted. Utilization of MRI of the brain, neurologic consultation, swallow evaluation, occupational therapy, and physical therapy was also extracted. Among 12,508 subjects, the median age was 2.8 months, ~50% had comorbid conditions, and the median duration of mechanical ventilation was 7 days. The percentage of children prescribed greater than or equal to five drugs/drug classes increased over the study period from 36.5% to 55.8% (p < 0.001). There were significant increases over time in utilization of 10 of the 15 individual drugs/drug classes analyzed. More than half of subjects (6,294 [50.3%]) received at least one service that evaluates/treats neurologic morbidity. There were significant increases in the use of greater than or equal to one service (36.3% in 2006 to 59.6% in 2015; p < 0.001) and in the use of greater than or equal to two services (20.8% to 34.8%; p < 0.001). Utilization of each of the five individual resources increased significantly during the study period, but use of vasoactive medications and mortality did not. CONCLUSIONS: Prescription of neuropharmacologic agents increased over time using metrics of both overall drug burden and specific drug usage. Concurrently, the utilization of services that evaluate and/or treat neurologic morbidity was common and also increased over time.

Full Text

Duke Authors

Cited Authors

  • Shein, SL; Slain, K; Wilson-Costello, D; McKee, B; Rotta, AT

Published Date

  • December 2017

Published In

Volume / Issue

  • 18 / 12

Start / End Page

  • e606 - e614

PubMed ID

  • 28930813

Pubmed Central ID

  • 28930813

International Standard Serial Number (ISSN)

  • 1529-7535

Digital Object Identifier (DOI)

  • 10.1097/PCC.0000000000001351

Language

  • eng

Conference Location

  • United States