(1209) Post-Extubation Noninvasive Respiratory Support for Pediatric ARDS

Introduction: Pediatric ARDS (PARDS) is a common cause of severe respiratory failure, and many patients require mechanical ventilation. PARDS survivors may need post extubation noninvasive respiratory support (NRS) via high-flow nasal cannula, CPAP, or noninvasive ventilation (NIV). This study aimed to describe the post extubation NRS use in children with PARDS.

Methods: We performed a retrospective, post-hoc analysis of the PARDIE study and compared extubated subjects receiving NRS to those who did not. Logistic regression tested the associations between risk factors and post extubation NRS use.

Results: We studied 468 subjects (median age 2.2 [IQR 0.5-8.7] years) and NRS was used in 262 (56%). Demographics, cause of respiratory failure, time of PARDS from ICU admission, PRISM4, ARDS severity, and the use of NIV prior to intubation were similar between NRS and no NRS groups. NRS use varied between regions, were less likely to be used in subjects of Hispanic or Latino ethnicity, and those with comorbidities, and/or neuromuscular disease. During mechanical ventilation, the NRS group was more likely to receive inhaled beta2 agonists, be on pressure support ventilation on the day of extubation, and have a set rate. There were no differences between groups in the use of high frequency ventilation, ECMO, inhaled nitric oxide, corticosteroids, vasoactive infusion score, prone positioning, or duration of mechanical ventilation. Subjects treated with NRS spent more time in the ICU (median 13.7 [IQR 8.3-24.5] vs 10.1 [IQR 6.3-17.6] days, P< 0.01). Increasing age (OR 0.95, 95% CI 0.92-0.99), increasing PRISM4 (OR 0.18, 95% CI 0.04-0.85), and longer duration of invasive ventilation (OR 0.98, 95% CI 0.96-0.99) were associated with a decreased odds of NRS use post extubation. Being from North America (OR 2.41, 95% CI 1.26-4.68), immunocompromised (OR 2.45, 95% CI 1.09-5.9), and neuromuscular disease (OR 2.96, 95% CI 1.51-6.1) were associated with an increased odds of NRS use post extubation.

Conclusions: Over half of subjects received NRS post extubation after PARDS. Neuromuscular disease, being in North America, and being immunocompromised were associated with an increased use of NRS while increasing age, longer duration of mechanical ventilation, and higher PRISM4 were associated with lower likelihood of NRS use.