Evaluation of the BronchiolitisMAD protocol in the out-of-hospital emergency services of the Community of Madrid

Abstract

The objective of this study was to evaluate the BronchiolitisMAD protocol after its implementation in the out-of-hospital emergency services (OHES) of the Autonomous Community of Madrid (ACM), assessing the clinical improvement during the transfer, application of adequate respiratory therapy, and reduction of response times. This is a descriptive, cross-sectional, and retrospective study in the OHES of the ACM, comparing the season prior to the establishment of the BronchiolitisMAD protocol (October 1, 2019, to March 31, 2020) and the subsequent season (October 1, 2022, to March 31, 2023), excluding the epidemic period of the COVID-19 pandemic. The protocol's key point is a stepwise approach based on the severity of the child's bronchiolitis. It provides detailed algorithms and checklists for treatment and transfer decisions. Specific instructions are provided for using an incubator during the transport of critically ill infants. Seventy-nine patients were included. In the post-protocol season, the use of non-invasive mechanical ventilation increased (from 7.5% to 51.3%) in a statistically significant manner. When comparing the initial and final assessment of the patient pre- and post-protocol, in the post-protocol season, there was a reduction in tachycardia (from 71.8% to 42.3%) and tachypnea (from 69.2% to 46.2%), with an increase in the SaFi ratio (p<0.05). A reduction in T1-activation and T2-stabilization times was observed. The BronchiolitisMAD protocol allowed the implementation and generalization of up-to-date care for infants with acute bronchiolitis.

Keywords

• Bronchiolitis
• paediatric emergency care
• out-of-hospital urgent care
• emergency care
• protocol
• respiratory viruses