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Bulb vs Suction Gadget – Does Type of Nasal Suctioning Help Infants with Bronchiolitis?

November 23, 2023

Happy Thanksgiving!
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Written by Christopher Thom

Spoon Feed
In a randomized controlled trial of discharged infants with bronchiolitis, enhanced home nasal suctioning with a mechanical device did not lead to reduced unscheduled health care revisits as compared to standard bulb suctioning.

If only parental sleep had increased…
Nasal suctioning is frequently performed in infants with bronchiolitis, but the actual type of suctioning performed has been subject to minimal study.  

This RCT enrolled 367 infants without serious co-morbidities who were being discharged with an ED diagnosis of bronchiolitis. The study occurred at 4 tertiary care EDs in Canada, with an age of enrollment of 4 weeks to 11 months. Patients randomized to the intervention group received a mechanical nasal suction device (Zo-Li), while those in the control group were assigned to a standard bulb syringe suction device. Outcomes evaluated were additional resource usage, unscheduled revisits for bronchiolitis, overall care satisfaction, infant sleeping, and parental sleeping.

21.9% of patients had an unscheduled revisit by 72 hours in the enhanced suction group, as compared to 25.5% in the blub syringe cohort (p=0.46). Other outcomes including patient sleep, parental sleep, and satisfaction with care were not statistically different. However, there were more patients who received additional suctioning devices aside from their assigned device in the bulb syringe group (37%) as compared to the enhanced suction group (26.2%), p=0.03. Additionally, 79.2% of caregivers in the enhanced suction group were satisfied with their device, which was higher than that of the bulb syringe cohort (33.7%), p<0.001).

How will this change my practice?
While health care revisits did not differ, there was a higher parental satisfaction with the device and a lower number of patients receiving additional suctioning devices in the enhanced group. While the study did not demonstrate improved outcomes in patients receiving enhanced at home nasal suctioning, these devices were not harmful and may be looked upon more favorably by caregivers of these patients. 

Nasal Suctioning Therapy Among Infants With Bronchiolitis Discharged Home From the Emergency Department: A Randomized Clinical TrialJAMA Netw Open. 2023;6(10):e2337810. Published 2023 Oct 2.

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