(339) Risk Factors for Escalating From HFNC to NIV in Patients With Bronchiolitis Admitted to the PICU

Introduction: Acute bronchiolitis is a leading cause of admission in hospitals around the world. It is the most frequent reason for hospitalization of children younger than 2 years. Approximately 2–6% of these patients require admission to a pediatric intensive care unit (PICU) and usually require respiratory support. We studied the risk factors of patients with bronchiolitis to escalate respiratory support to noninvase ventilation (NIV) or invasive mechanical ventilation (IMV).

Methods: It was a single-center, retrospective study based on data from the electronic health record (EHR). The study was approved by IRB of Hospital Israelita Albert Einstein, São Paulo, Brazil. Patients < 2y with bronchiolitis admitted to the PICU were enrolled from January 2022 to December 2022. Patients requiring respiratory support were analyzed. We used univariate regression analysis to establish risk correlation to escalate the respiratory support to NIV or invasive mechanical ventilation (IMV). We used the software R (R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/).

Results: 273 patients were admitted to the PICU during 2022. Male sex prevailed (154/56.4%), the median age was 5.8 months, the median weight was 7.5 kg, the median length of hospital stay was 5 days, and the median of PICU stay was 3 days. 117 (26.5%) patients required respiratory support with HFNC, 24 (8.5%) patients required NIV, and 15 (5.3%) patients required IMV. Variables associated with the main outcome (NIV or IMV) were age (p=0.01); heart rate at admission (p=0.03); and respiratory rate at admission (p=0.01). We also found that the chance of deterioration of any form of respiratory support for non-invasive or invasive ventilation was 4.52 (95% CI 1.5 – 13.4, p = 0.007) for respiratory syncytial virus RSV, compared to other viruses.

Conclusions: Patients with bronchiolitis admitted to the PICU at a younger age, with higher heart and respiratory rates at admission were at risk of escalating respiratory support to NIV or IMV. Patients with RSV have a higher chance of requiring more respiratory support (NIV or IMV) compared to patients with other viruses.