(1441) Influence of the COVID-19 Pandemic on Pediatric Critical Care Procedures in Opioid Overdoses

Introduction: Drug overdose and fentanyl deaths in adolescents aged 10-19 years peaked during the COVID-19 pandemic. Critical care respiratory procedures and extracorporeal membrane oxygenation (ECMO) are important in the management of both severe opioid overdoses and COVID-19. We hypothesize that the judicial allocation of resources during the COVID-19 pandemic limited the per case use of these procedures.

Methods: This was a multicenter, retrospective cohort of de-identified patients >2 to 21-years-old from January 2019 to June 2023 within the Virtual Pediatric Intensive Care Unit (PICU) Systems database coded to opioid analgesics. Data were categorized into three time-periods: Pre-COVID (January 1, 2019-February 28, 2020), Peak-COVID (March 1, 2020-August 10, 2021), and Post-COVID (August 11, 2021-June 30, 2023). Procedures were sorted by respiratory procedures and ECMO for the respective time periods. Differences in categorical variables were assessed using either Chi-Square or Fisher’s Exact Test.

Results: Of the 1,764 opioid overdoses, 600 cases were pre-COVID, 569 peak-COVID, and 595 post-COVID. Total respiratory procedures per overdose case were 0.54, 0.63, and 0.71 for the pre-, peak-, and post-COVID periods, respectively. The use of respiratory procedures increased significantly from pre- to peak-COVID (p=0.002) and continued through post-COVID (p=0.007). However, the rates of endotracheal intubation use were 0.31, 0.31, and 0.33, respectively, without statistical differences. The rates of tracheostomy tubes, BiPAP, and humidified high flow (HHF) oxygen use increased throughout the periods. The rates of ECMO use were low and not significantly different.

Conclusions: The rates of non-invasive modes of ventilation increased from pre- to peak- to post-COVID periods while endotracheal intubation rates remained stable. The trend suggests that the number of severe opioid overdoses increased since 2019, potentially reflecting increase in potency of the opioid exposure and/or raise in intentional overdoses by adolescents. Concurrently, pediatric critical care providers have become more comfortable with use the of non-invasive ventilation for opioid overdoses, particularly HHF, and have rationed endotracheal ventilation for the most severe cases.