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Deep suctioning increases length of stay in infants with bronchiolitis


 

FROM JAMA PEDIATRICS

Deep suctioning and long lapses between suction treatments were associated with significantly increased lengths of stay in babies hospitalized with bronchiolitis.

Patients who never had deep suctioning stayed a little more than a day, but the length of stay was more than 2 days in patients for whom deep suctioning accounted for 60% or more of their treatments, Dr. Grant M. Mussman and his colleagues reported in the March 4 online issue of JAMA Pediatrics (2013[doi:10.1001/jamapediatrics.2013.36]).

Similarly, patients who experienced several lapses of 4 hours between treatments were hospitalized significantly longer than were those with no treatment lapses (mean of 2.3 days vs. 1.7 days).

Compared with a noninvasive nasal-type suction device, deep suctioning may aggravate the bronchial swelling and mucus sloughing that already causes breathing problems in these tiny patients, wrote Dr. Mussman of Cincinnati Children’s Hospital Medical Center.

"[It] may be that deep suctioning causes edema and irritation of the upper airway. Alternatively, noninvasive suctioning could be more effective in mobilizing nasal secretions through the larger caliber catheter."

Regular treatments with no lapses probably keep the airways open more consistently, they noted. "It is also possible that regular suctioning results in agitation of the patient, with resultant increased minute volume and secretion mobilization, resulting in shorter length of stay."

The study cohort consisted of 740 patients who were studied for device type (deep or noninvasive), 695 of which were studied for treatment timing. The patients were a mean of 6 months old, and all had been hospitalized for bronchiolitis.

Deep suction was defined as the insertion of a nasopharyngeal catheter, and noninvasive as the use of nasal-type aspirators, excluding bulb syringe. The exposure was the percentage of treatments that used deep suctioning (0%-35%; more than 35%-60%; and more then 60%).

The adjusted mean length of stay for infants who had no deep suctioning was 1.75 days. The stay was 1.91 days for those with up to 35% deep suctioning, 1.96 days for more than 35%-60% deep suctioning, and 2.35 days for more than 60% deep suctioning.

For the suction treatment timing group, a suctioning lapse was defined as two sequential suctioning events separated by more than 4 hours during the first 24 hours of admission. The investigators said that the 4-hour increment is the most common reassessment timing.

Infants with no treatment lapses had a mean adjusted hospital stay of 1.62 days. In contrast, the mean length of stay was 1.72 days for infants with one treatment lapse, 2.09 days for those with two lapses, and 2.64 days for those with three or four lapses.

"We believe the difference in geometric mean of up to 1 day between patients with no suctioning lapses and those with three or four lapses is clinically meaningful," the authors noted. However, "Because there is insufficient data to determine a causal relationship, we intend to continue to examine these associations as we incorporate these findings into clinical practice at our institution."

Dr. Mussman had no relevant financial disclosures.

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