Brittany L Shutes1, Ambrish B Patel1, Melissa D Moore-Clingenpeel2, Asuncion Mejias3, Todd J Karsies4. 1. Nationwide Children's Hospital, 2650, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Columbus, Ohio, United States. 2. Nationwide Children\'s Hospital, 2650, Biostatistics Core, Columbus, Ohio, United States. 3. Nationwide Children's Hospital, 2650, Department of Pediatrics, Division of Infectious Disease, Columbus, Ohio, United States. 4. Nationwide Children's Hospital, 2650, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Columbus, Ohio, United States; todd.karsies@nationwidechildrens.org.
Abstract
RATIONALE: Although respiratory virus testing is frequent done for critically ill infants with bronchiolitis, the prognostic value of this testing is unknown for those requiring positive pressure ventilation (PPV). OBJECTIVES: To determine the differences in PPV utilization according to viral detection and to explore the association between viral detection and duration of PPV in critically ill children with presumed respiratory infection. METHODS: This is a retrospective cohort study in a quaternary pediatric intensive care unit from February 2014 until February 2017. We evaluated 984 children < 1 year of age who received PPV for presumed respiratory infection without significant congenital heart disease, care limitations, baseline PPV usage, or tracheostomy. Respiratory viruses were identified using a PCR panel. Analyses of duration of PPV according to viral etiology were performed using univariate and multivariable logistic regression and truncated negative binomial regression with calculated mean marginal effect (MME). RESULTS: Overall, 85 (9%) infants had no viruses identified, 629 (64%) had a single virus detected, most commonly respiratory syncytial virus (RSV) (417, 42%) followed by rhinovirus/enterovirus (RV/EV) (145, 15%), 230 (23%) had 2 viruses detected, and 40 (4%) had three viruses detected. Compared to those with 1 or no virus detected, infants with ≥2 viruses received longer total PPV duration in adjusted analysis [RR:1.4 (95% CI 1.2-1.6); p<0.001, MME=29 hours]. Detection of RV/EV alone, compared to RSV alone, was associated with significantly shorter duration of total PPV [RR:0.7 (95% CI 0.62, 0.87); p=<0.001, MME= -23 hours], noninvasive PPV [RR: 0.7 (95% CI 0.60, 0.85); p<0.001 MME = -15 hours], and invasive PPV [RR 0.7 (95% CI 0.54, 0.83); p<0.001, MME = -54 hours) when adjusted for weight, prematurity, and administration of early antibiotic therapy. CONCLUSIONS: Identification of viral type and number in severe bronchiolitis is an important predictor of duration of PPV.
RATIONALE: Although respiratory virus testing is frequent done for critically illinfants with bronchiolitis, the prognostic value of this testing is unknown for those requiring positive pressure ventilation (PPV). OBJECTIVES: To determine the differences in PPV utilization according to viral detection and to explore the association between viral detection and duration of PPV in critically illchildren with presumed respiratory infection. METHODS: This is a retrospective cohort study in a quaternary pediatric intensive care unit from February 2014 until February 2017. We evaluated 984 children < 1 year of age who received PPV for presumed respiratory infection without significant congenital heart disease, care limitations, baseline PPV usage, or tracheostomy. Respiratory viruses were identified using a PCR panel. Analyses of duration of PPV according to viral etiology were performed using univariate and multivariable logistic regression and truncated negative binomial regression with calculated mean marginal effect (MME). RESULTS: Overall, 85 (9%) infants had no viruses identified, 629 (64%) had a single virus detected, most commonly respiratory syncytial virus (RSV) (417, 42%) followed by rhinovirus/enterovirus (RV/EV) (145, 15%), 230 (23%) had 2 viruses detected, and 40 (4%) had three viruses detected. Compared to those with 1 or no virus detected, infants with ≥2 viruses received longer total PPV duration in adjusted analysis [RR:1.4 (95% CI 1.2-1.6); p<0.001, MME=29 hours]. Detection of RV/EV alone, compared to RSV alone, was associated with significantly shorter duration of total PPV [RR:0.7 (95% CI 0.62, 0.87); p=<0.001, MME= -23 hours], noninvasive PPV [RR: 0.7 (95% CI 0.60, 0.85); p<0.001 MME = -15 hours], and invasive PPV [RR 0.7 (95% CI 0.54, 0.83); p<0.001, MME = -54 hours) when adjusted for weight, prematurity, and administration of early antibiotic therapy. CONCLUSIONS: Identification of viral type and number in severe bronchiolitis is an important predictor of duration of PPV.