Rationing in the Pediatric Intensive Care Unit-ethical or unethical?

Rationing in health care is controversial, and even more so in pediatrics. Children are an inherently vulnerable group because they are reliant on their parents and caregivers to make decisions in their best interests and have no political voice. Historically, there has been general acceptance of the need to ration healthcare at a systems level, however there is controversy over whether healthcare professionals should be involved in rationing at the bedside.

Humidified high-flow nasal cannula oxygen in bronchiolitis reduces need for invasive ventilation but not intensive care admission.

Aim: To describe the changes to paediatric intensive care unit (PICU) admission patterns and ventilation requirements for children with bronchiolitis following the introduction of humidified high-flow nasal cannula oxygen outside the PICU.

Methods: Retrospective study comparing patients <24 months of age with a discharge diagnosis of bronchiolitis admitted to the PICU. A comparison was made between those before humidified high-flow nasal cannula oxygen use (year 2008) to those immediately following the introduction of humidified high-flow nasal cannula oxygen use (year 2011) and those following further consolidation of humidified high-flow nasal cannula oxygen use outside the PICU (year 2013).