Factors that May Predict the Need for Invasive Mechanical Ventilation in Severe Acute Bronchiolitis

Abstract

Objective: Severe acute bronchiolitis patients may require mechanical ventilation despite other non-invasive respiratory support modalities in the intensive care unit. Referral of the patients who may require intubation to experienced centers, may reduce invasive ventilation associated complications. The objective of this study is to determine the risk factors at PICU admission that may predict the mechanical ventilation requirement in severe acute bronchiolitis patients. Methods: Retrospective chart review of patients admitted to the PICU due to severe acute bronchiolitis between 01.08.2018-01.11.2019 were included in to the study. Results: One hundred and five patients were enrolled. High flow nasal cannula was used in 70 patients (66.6%), non-invasive ventilation (spontaneous/time mode) was used in 19 (18.1%) patients and invasive mechanical ventilation was used in 16 (15.3%) patients. Birth weight (Odds Ratio [OR]:0.99), admission weight (OR:0.749), age in months (OR:0.763), history of prematurity (OR:3.06), presence of chronic respiratory diseases (OR:4.61), presence of chronic cardiac diseases (OR:3.23) and respiratory syncytial virus infection (OR:4.37) were significant for intubation requirement in logistic regression analysis. Age ≤4 months (sensitivity: 50% specificity: 85.3%) and birth weight ≤3000 g (sensitivity: 75% specificity: 75.8%) were found significant in receiver operating characteristics curve analysis. Conclusion: Invasive mechanical ventilation in severe acute bronchiolitis is a challenging process that requires experience. History of prematurity without chronic lung disease appears not to be a significant risk factor for intubation. Patients with chronic lung disease, low birth weight, history of prematurity especially when these are complicated with RSV infection should be transferred to experienced centers in the early period.