SARS-CoV-2-related bronchiolitis: a multicentre international study.

BACKGROUND: Bronchiolitis is the main acute lower respiratory tract infection in infants. Data regarding SARS-CoV-2-related bronchiolitis are limited. OBJECTIVE: To describe the main clinical characteristics of infants with SARS-CoV-2-related bronchiolitis in comparison with infants with bronchiolitis associated with other viruses. SETTING, PATIENTS, INTERVENTIONS: A multicentre retrospective study was conducted in 22 paediatric emergency departments (PED) in Europe and Israel. Infants diagnosed with bronchiolitis, who had a test for SARS-CoV-2 and were kept in clinical observation in the PED or admitted to hospital from 1 May 2021 to 28 February 2022 were considered eligible for participation. Demographic and clinical data, diagnostic tests, treatments and outcomes were collected. MAIN OUTCOME MEASURES: The main outcome was the need for respiratory support in infants testing positive for SARS-CoV-2 compared with infants testing negative. RESULTS: 2004 infants with bronchiolitis were enrolled. Of these, 95 (4.7%) tested positive for SARS-CoV-2. Median age, gender, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative infants. Human metapneumovirus and respiratory syncytial virus were the viruses most frequently detected in the group of infants negative for SARS-CoV-2.Infants testing positive for SARS-CoV-2 received oxygen supplementation less frequently compared with SARS-CoV-2-negative patients, 37 (39%) vs 1076 (56.4%), p=0.001, OR 0.49 (95% CI 0.32 to 0.75). They received less ventilatory support: 12 (12.6%) high flow nasal cannulae vs 468 (24.5%), p=0.01; 1 (1.0%) continuous positive airway pressure vs 125 (6.6%), p=0.03, OR 0.48 (95% CI 0.27 to 0.85). CONCLUSIONS: SARS-CoV-2 rarely causes bronchiolitis in infants. SARS-CoV-2-related bronchiolitis mostly has a mild clinical course.

Comparison of three intraosseous access devices for resuscitation of term neonates: a randomised simulation study.

OBJECTIVES: To compare the success rates and ease of use of three intraosseous (IO) access devices used in term neonates. DESIGN: A three-arm randomised controlled simulation study was conducted. SETTING: A simulation laboratory. PARTICIPANTS: Seventy-two paediatric residents completing their emergency department rotation as part of their residency training, and 20 paediatric specialists. INTERVENTION: Using an animal bone model, the one-attempt success rate of the EZ-IO drill, the NIO-I needle and the Jamshidi needle was compared. Uncooked Cornish Hen bones were used because of their similarity in length and diameter to the bones of neonates. Participants were asked to record the perceived ease of use of their assigned device using a 5-point Likert Scale. MAIN OUTCOME MEASURE: The main outcome was the visualisation of flow emerging from the distal end of the bone, and perceived ease of use of the three IO devices. RESULTS: The EZ-IO, NIO-I and Jamshidi groups included 30, 31 and 31 participants, respectively, with median (IQR) years of experience of 3 (2-5), 3 (2-6) and 4 (3-5) years. Participants had significantly lower one-attempt success rates with the EZ-IO drill than with the NIO-I and the Jamshidi needles (14 of 30 (46.7%) vs 24 of 31 (77.4%); p=0.016, and 14 of 30 (46.7%) vs 25 of 31 (80.7%); p=0.007, respectively). The median (IQR) ease-of-use score of the EZ-IO drill was higher than that of the NIO-I and Jamshidi needles (5 (4-5) vs 4 (4-5); p=0.008, and 5 (4-5) vs 4 (3-4); p=0.0004, respectively). CONCLUSIONS: Although easier to use, the EZ-IO drill demonstrated lower success rates than the IO needles in establishing IO access on a neonatal bone model.

Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study.

BACKGROUND: In the prehospital setting, endotracheal intubation (ETI) may be required to secure the coronavirus disease 2019 (COVID-19) patient airway. It has been suggested that the use of a protective barrier can reduce possible aerosol delivery from patients to clinicians during ETI. We sought to assess the performance of ETI by paramedics wearing personal protective equipment with and without the use of a box barrier. METHODS: A randomized, crossover simulation study was performed in a simulation laboratory. Study participants were 18 paramedics actively working in the clinical environment. Participants' performance of ETI via direct laryngoscopy (DL) with and without the use of a box barrier was assessed. The sequence of intubation was randomized to either BoxDL-first or DL-first. The primary outcome was the success rate of ETI on first-attempt. The secondary and tertiary outcomes were ETI success rates on three attempts and total intubation time, respectively. RESULTS: There were no differences between the DL group and the BoxDL group in one-attempt success rates (14/18 vs 12/18; P = 0.754), and in overall success rates (16/18 vs 14/18; P = 0.682). The mean (standard deviation) of the total intubation times for the DL group and the BoxDL group were 27.3 (19.7) seconds and 36.8 (26.2) seconds, respectively (P < 0.015). CONCLUSIONS: The findings of this pilot study suggest that paramedics wearing personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID-19 patients remain to be investigated.

Early unplanned return visits to a pediatric emergency department in Israel.

BACKGROUND: Early unplanned return visits (EURV) to the emergency department (ED) are stressful for children and caregivers. Dissatisfaction with the first ED visit could influence the decision to revisit the ED. The aim was to evaluate comprehensively parents' satisfaction with the first ED visit. METHODS: A prospective questionnaire-based study of parents of EURV patients was conducted in a pediatric ED. Participants were enrolled based on convenience sampling. The study instrument was the parental satisfaction questionnaire (PSQ). The 27 PSQ items evaluate four themes related to satisfaction: attitude and respect, information provided, continuity of care, and waiting times. Items are rated on a five-point Likert scale. RESULTS: During the 18-month study, 101 parents of EURV patients were surveyed and 98 agreed to participate. On the return visit, 63 EURV patients were discharged and 35 EURV patients were hospitalized. Eighty-seven (88.7%) caregivers scored an overall level of satisfaction with the first visit of 8-10 on a 10-point Likert scale. Median scores in 22 PSQ items were 4 (interquartile range [IQR] 4-5) or 4 (IQR 3-4). Median scores for "physicians attention and answering questions and concern" and "physicians clear and understood explanations" were 3 (IQR 3-4) and 2 (IQR 2-3), respectively. The PSQ scores were similar for patients who were discharged on the return visit and patients who were hospitalized. CONCLUSIONS: Parents were satisfied with the care provided at the first ED visit. There was a lower level of satisfaction with physician interaction.