Abstract：
We present guidelines for the management of infants under 12 months of age with severe bronchiolitis with the aim of creating a series of pragmatic recommendations for a patient subgroup that is poorly individualized in national and international guidelines.
Twenty-five French-speaking experts, all members of the Groupe Francophone de Réanimation et Urgence Pédiatriques (French-speaking group of paediatric intensive and emergency care; GFRUP) (Algeria, Belgium, Canada, France, Switzerland), collaborated from 2021 to 2022 through teleconferences and face-to-face meetings. The guidelines cover five areas: (1) criteria for admission to a pediatric critical care unit, (2) environment and monitoring, (3) feeding and hydration, (4) ventilatory support and (5) adjuvant therapies. The questions were written in the Patient-Intervention-Comparison-Outcome (PICO) format. An extensive Anglophone and Francophone literature search indexed in the MEDLINE database via PubMed, Web of Science, Cochrane and Embase was performed using pre-established keywords. The texts were analyzed and classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. When this method did not apply, an expert opinion was given. Each of these recommendations was voted on by all the experts according to the Delphi methodology.
This group proposes 40 recommendations. The GRADE methodology could be applied for 17 of them (3 strong, 14 conditional) and an expert opinion was given for the remaining 23. All received strong approval during the first round of voting.
These guidelines cover the different aspects in the management of severe bronchiolitis in infants admitted to pediatric critical care units. Compared to the different ways to manage patients with severe bronchiolitis described in the literature, our original work proposes an overall less invasive approach in terms of monitoring and treatment.
Twenty-five French-speaking experts, all members of the Groupe Francophone de Réanimation et Urgence Pédiatriques (French-speaking group of paediatric intensive and emergency care; GFRUP) (Algeria, Belgium, Canada, France, Switzerland), collaborated from 2021 to 2022 through teleconferences and face-to-face meetings. The guidelines cover five areas: (1) criteria for admission to a pediatric critical care unit, (2) environment and monitoring, (3) feeding and hydration, (4) ventilatory support and (5) adjuvant therapies. The questions were written in the Patient-Intervention-Comparison-Outcome (PICO) format. An extensive Anglophone and Francophone literature search indexed in the MEDLINE database via PubMed, Web of Science, Cochrane and Embase was performed using pre-established keywords. The texts were analyzed and classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. When this method did not apply, an expert opinion was given. Each of these recommendations was voted on by all the experts according to the Delphi methodology.
This group proposes 40 recommendations. The GRADE methodology could be applied for 17 of them (3 strong, 14 conditional) and an expert opinion was given for the remaining 23. All received strong approval during the first round of voting.
These guidelines cover the different aspects in the management of severe bronchiolitis in infants admitted to pediatric critical care units. Compared to the different ways to manage patients with severe bronchiolitis described in the literature, our original work proposes an overall less invasive approach in terms of monitoring and treatment.
摘要：
目的：我们提出了12月龄以下严重细支气管炎婴儿的治疗指南，旨在为国家和国际指南中缺乏个性化的患者亚组提出一系列务实的建议。
方法：25位法语专家，FranophonedeRéanimationetUrgencePédiatriques（法语儿科重症和急诊护理小组；GFRUP）的所有成员（阿尔及利亚，比利时,加拿大,法国,瑞士),从2021年到2022年，通过电话会议和面对面会议合作。该指南涵盖五个方面：（1）儿科重症监护病房的入院标准，(2)环境与监测,（3）喂养和水化，（4）通气支持和（5）辅助治疗。问题以患者干预比较结果（PICO）格式编写。通过PubMed在MEDLINE数据库中索引了广泛的英语和法语文献搜索，WebofScience,使用预先建立的关键字执行Cochrane和Embase。根据建议评估的等级对文本进行分析和分类，开发和评估(等级)方法。当此方法不适用时，给出了专家意见。所有专家都根据Delphi方法对这些建议进行了投票。
结果：该小组提出了40条建议。等级方法可以应用于其中的17个(3个强，14条件性)，并对其余23个给出了专家意见。在第一轮投票中，所有人都获得了强烈的批准。
结论：这些指南涵盖了儿科重症监护病房婴儿重症细支气管炎管理的不同方面。与文献中描述的治疗严重毛细支气管炎患者的不同方法相比，我们的原始工作在监测和治疗方面提出了一种总体上侵入性较小的方法.
方法：25位法语专家，FranophonedeRéanimationetUrgencePédiatriques（法语儿科重症和急诊护理小组；GFRUP）的所有成员（阿尔及利亚，比利时,加拿大,法国,瑞士),从2021年到2022年，通过电话会议和面对面会议合作。该指南涵盖五个方面：（1）儿科重症监护病房的入院标准，(2)环境与监测,（3）喂养和水化，（4）通气支持和（5）辅助治疗。问题以患者干预比较结果（PICO）格式编写。通过PubMed在MEDLINE数据库中索引了广泛的英语和法语文献搜索，WebofScience,使用预先建立的关键字执行Cochrane和Embase。根据建议评估的等级对文本进行分析和分类，开发和评估(等级)方法。当此方法不适用时，给出了专家意见。所有专家都根据Delphi方法对这些建议进行了投票。
结果：该小组提出了40条建议。等级方法可以应用于其中的17个(3个强，14条件性)，并对其余23个给出了专家意见。在第一轮投票中，所有人都获得了强烈的批准。
结论：这些指南涵盖了儿科重症监护病房婴儿重症细支气管炎管理的不同方面。与文献中描述的治疗严重毛细支气管炎患者的不同方法相比，我们的原始工作在监测和治疗方面提出了一种总体上侵入性较小的方法.
