231 - Nasal Aspiration versus Deep Suctioning in Bronchiolitis: A Prospective Observational Study

Poster Number: 231
Publication Number: 231.3277

Background: Suctioning practices of nasal aspiration and deep suctioning vary among healthcare practitioners in the management of bronchiolitis. The American Academy of Pediatrics does not provide specific suctioning recommendations due to insufficient data favoring either approach. To date, there are no studies in the emergency department (ED) evaluating the associations between suction types and their clinical outcomes in bronchiolitis.

Objective: Explore associations between suction type on respiratory distress and oxygen saturation (O2 sat) improvements, and markers of respiratory compromise such as airway escalation, disposition, ED length of stay (LOS), and outpatient outcomes.

Design/Methods: This was a prospective observational study on infants (age 2-23 months) in a pediatric ED with clinical bronchiolitis during a full respiratory season from September 2022 to April 2023. Infants with tracheostomies, muscular weakness, and non-invasive positive pressure ventilation were excluded. Infants were categorized into nasal aspiration, deep suctioning, or a combination group. Marlais respiratory scores (primary outcome) and O2 sat were recorded before suction and at 30 and 60 minutes post-suction. Escalation to airway adjuncts, patient disposition, and ED LOS were recorded. Families of discharged infants were called to determine continued severity of symptoms and parental burden at 3 days after discharge. Analyses were done using 2-way Mixed ANOVA, Kruskal-Wallis, and Fisher Exact Test.

Results: A total of 121 were enrolled (nasal aspiration n=31, deep suctioning n=68, combination n=22) and 48% (n=58) were discharged with a call back rate of 88% (n=51). There was no interaction between suction type and timepoint and no effect between suction type and respiratory score. However, timepoint did have an effect on respiratory score between 0 and 30 minutes post-suction (mean difference -0.336 [95CI -0.060 to -0.612] p=0.011) and between the 0 and 60 minutes post-suction (mean difference -0.494 [95CI -0.194 to -0.794] p< 0.001) (Figure 1). There was no difference between 30 and 60 minutes post-suction. Admitted patients received more deep suctioning or a combination of suctioning compared to those discharged (p=0.005) (Table 1). Suction type had no effect on O2 sat, escalation to airway adjuncts, ED LOS, or outpatient outcomes including repeat visits, symptom duration, and days of missed work or daycare (p>0.114) (Table 2).

Conclusion(s): There was no difference in respiratory scores and outpatient outcomes between suction types. Deep suctioning may not be superior to nasal aspiration for dischargeable bronchiolitis infants.