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Management of severe bronchiolitis: impact of NICE guidelines
  1. Benedict Griffiths,
  2. Shelley Riphagen,
  3. Jon Lillie
  1. South Thames Retrieval Service, Paediatric Intensive Care Unit, Evelina London Children’s Hospital, London, UK
  1. Correspondence to Dr Benedict Griffiths, Paediatric Intensive Care, Evelina London Children’s Hospital, London SE1 7EH, UK; bgriffiths{at}


Objective To understand the impact of the National Institute for Health and Care Excellence (NICE) bronchiolitis guidelines on the management of children referred to paediatric intensive care unit (PICU) with bronchiolitis.

Design and setting Data were collected on all children referred to a regional PICU transport service with the clinical diagnosis of bronchiolitis during the winter prior to the NICE consultation period (2011–2012) and during the winter after publication (2015–2016). Management initiated by the referring hospital was assessed.

Results There were 165 infants referred with bronchiolitis in epoch 1 and 187 in epoch 2. Nebuliser use increased from 28% in epoch 1 to 53% in epoch 2. Increased use of high-flow nasal cannula oxygen and reduction in continuous positive airway pressure use were observed. The use of antibiotics did not change between epochs.

Conclusion The use of nebulised therapies has increased in the management of severe bronchiolitis despite national guidance to the contrary.

  • bronchiolitis
  • nebuliser
  • guidelines

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  • Contributors JL and SR designed the study. JL and BG collected and analysed the data. All three authors were involved in writing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.