G441 Bronchiolitis in picu: who struggles to survive?

Abstract

AimCharacteristics of children with bronchiolitis requiring PICU, causative organisms, PICU length of stay and outcome.MethodsCase control study of all patients <2 years who were admitted with bronchiolitis (SIGN guidelines) between 01/2014– 05/2016 to a tertiary level PICU.Results80 children were admitted with the following demographics: Median age 2 months, IQR: 4.5 months. 59/80 (74%) admissions matched seasonal distribution (November–March). 37/80 (46%) patients had comorbidities (prematurity, cardiac, immunodeficiency). Level of respiratory support: non-invasive ventilation: 5% (4/80), conventional ventilation: 72.5% (58/80), high frequency oscillation ventilation (HFOV): 21% (17/80) and one ECMO case. Comorbidity was a risk factor for HFOV in 65% (11/17). Indication for intubation was: apnoea 27/76 (36%), respiratory acidosis 49/76 (64%). Nasopharyngeal aspirate (NPA) was positive in 64/80: 31 RSV A, 14 RSV B, 8 Parainfluenza, 3 Rhinovirus, 3 CMV, 2 Metapneumovirus, 2 Adenovirus, and 1 Influenza A.Total RSV positive NPA: 45/80 (56%). 6/31 RSV A positive patients had non-typeable Haemophilus Influenzae (NTHi) with sightly longer median ventilation days (5.5 vs 4 days). RSV infection accounted for majority of HFOV children 59% (10/17), and was responsible for 59.3% (16/27) intubation for apnoea, 59.2% (29/49) for respiratory acidosis. Comorbidities group had longer ventilation days and PICU length of stay compared with patients with no associated morbidities (6 days vs 4 days, p<0.16), and (10 days vs 5 days, p<0.006) respectively. Post extubation: 20/35 patients with comorbidities required high level of O2 support (NIV, HFNC) compared with 12/41 patients without comorbidities (57% vs 29%, OR:3.04). Mortality was significant in the comorbidities cohort (2 preterm, 2 immunocompromised) compared with none in the group with no comorbidities (11% vs 0%).ConclusionsBronchiolitis remains a common cause for seasonal admission to PICU with significant length of stay, morbidity, and mortality for those with comorbidities. Concern about its associated cost is still a major challenge. Respiratory acidosis was twice as common cause for intubation. RSV was the most common encountered pathogen (56%) despite palivizumab introduction in 2010. We noticed unclear association of NTHi with RSV A infection. It is interesting to review preterm children who had palivizumab to see if they are underrepresented in PICU and consider its use in immunocompromised children as they have a high mortality.

Pulmonary hypertension during respiratory syncytial virus bronchiolitis: a risk factor for severity of illness

“…In this study, prolonged ICU stay was defined as >10 days according to the median ICU stay in patients with comorbidities and it includes 25 percentile of patients reported by others. 24,25…”

Does caffeine prevent intubation in babies with bronchiolitis who present with apnoea?

“…In infants with RSV-positive bronchiolitis, the incidence of apnoea was reported to be 1.2%–23.8% in one study 4. This creates a great deal of pressure on the bed capacity in the intensive care units given the fact that most of the affected patients are expreterm babies who are at high risk of apnoeas 9…”