(855) Identifying Children Admitted to the PICU With LRTI Who Rapidly Wean Respiratory Support

Introduction: Studies show Pediatric Intensive Care Unit (PICU) admissions due to infectious lower respiratory tract infections are rising. In winter 2022-2023, a surge in respiratory illnesses overwhelmed PICU bed capacity, highlighting the need for better resource allocation. We hypothesize that there is a group of children admitted to the PICU for respiratory support who are not critically ill, manifested by rapid de-escalation of respiratory support by more than 25% of flow (l/kg/min) within 24 hours of admission.

Methods: We performed a retrospective chart review of patients 5 years and under admitted to the PICU requiring respiratory support above low flow oxygen due to any primary respiratory pathology in a 5-year period (2018-2023). A total of 1,628 patients met our inclusion criteria. Our exclusion criteria were tracheostomy, needing other critical care modalities (i.e. vasoactives), and transfers from inpatient units. Our data includes patient demographics, disease modifiers, and respiratory support at 0-,6-,12-, and 24-hours upon admission. Statistical analyses were performed using Chi2 tests for categorical variables and Wilcoxon rank-sum tests for continuous variables.

Results: Of the 104 patients reviewed, 79 (76.7%) were on high-flow nasal cannula (HFNC), 9 (8.7%) on non-invasive positive pressure ventilation (NIPPV), and 14 (13.6%) were intubated prior to PICU admission. Of the 88 patients on HFNC or NIVPP at admission, 11 (12.5%) at 6 hours, 28 (32.5%) at 12 hours, and 36 (40.9%) at 24 hours post-admission had their flow weaned by at least 25% and were thus not critically ill. Preliminary data analysis revealed no significant differences in age, gender, race, or gestational age between patients in either group.

Conclusions: We identified a substantial proportion of children admitted to the PICU requiring HFNC or NIVPP who may not be critically ill, as evidenced by rapid de-escalation within the first day. This suggests the existence of population who may not need the PICU. Future studies include further analysis of the complete cohort and additional risk factors such as comorbidities, emergency department therapies, and disease modifiers. Our goal is to identify risk factors associated with rapid de-escalation to develop a triage tool capable of predicting which patients require the PICU.