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Risk factors for intubation in severe bronchiolitis: a useful tool to decide on an early intensive respiratory

Jacopo Colombo1,2, Chiara Gattoni2, Alessandra Carobbio3

  • 1Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy.

Minerva Pediatrics
|June 5, 2020
PubMed

Insights

Severe bronchiolitis in infants requires prompt intervention. Key indicators for intubation in children include a Modified Wood's Clinical Asthma Score of 7 or higher, SpO2 levels of 75% or less, and the presence of apnea.

Area of Science:

  • Pediatrics
  • Critical Care Medicine
  • Respiratory Medicine

Background:

  • Bronchiolitis is a common lower respiratory infection in children under two years old, frequently necessitating hospitalization.
  • Respiratory Syncytial Virus (RSV) is the primary cause, followed by rhinovirus.
  • Lack of defined admission criteria for Pediatric Intensive Care Units (PICU) for severe bronchiolitis poses a challenge.

Purpose of the Study:

  • To identify risk factors associated with intubation in children with severe bronchiolitis admitted to the PICU.
  • To establish cut-off values for these risk factors to aid in clinical decision-making.

Main Methods:

  • Retrospective analysis of 93 children with severe bronchiolitis admitted to a PICU between 2013 and 2016.
  • Evaluation of fourteen variables, including clinical scores, oxygen saturation, and apnea, using univariate and multivariate logistic regression.
  • ROC analysis to determine critical cut-off values for identified risk factors.

Main Results:

  • Nineteen patients (20.4%) required intubation.
  • A Modified Wood's Clinical Asthma Score (M-WCAS) of 7 or higher, SpO2 ≤75%, and apnea were significantly associated with intubation.
  • ROC analysis identified specific cut-off values for these predictors.

Conclusions:

  • Established cut-off values for M-WCAS, SpO2, and apnea can assist pediatricians in timely decisions regarding respiratory support.
  • These findings may improve the management of severe bronchiolitis and reduce delays in intensive care.
  • Prompt identification of intubation risk factors can lead to more appropriate and timely respiratory support for critically ill infants.
Abstract

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