(792) A Descriptive Study of NIV-NAVA Utilization in Children With Bronchiolitis Admitted to the PICU

Introduction: Invasive ventilation has historically been utilized as a rescue modality for children with severe bronchiolitis. However, data suggests that non-invasive ventilation (NIV) can be effective and safe leading to reduced rates of intubation. In children with bronchiolitis, patient-ventilator asynchrony can be a major issue given rapid respiratory rates. To help reduce this asynchrony, we have started using neurally adjusted ventilatory assist (NAVA) mode of NIV in our PICU. This study aims to describe the use of NIV-NAVA in children with bronchiolitis between 2018 and 2022.

Methods: We used the Virtual Pediatric Systems, LLC database to identify children less than two years old with a diagnosis of bronchiolitis. We included children who were initiated on NIV-NAVA and excluded those with prior tracheostomy and those who were intubated prior to arrival at our hospital. We present clinical characteristics in the context of illness severity as determined by the Pediatric Index of Mortality, Version 3 (PIM3).

Results: Two hundred and nine children with bronchiolitis were identified; 42 met inclusion criteria, of whom 26 (62%) were males. The median (interquartile range) age and weight were 3 (1-9) months and 5.4 (4.2-8.1) kgs respectively. There were a total of 11 intubations, with rates that appeared to decline over the study period (rs= 0.39, p=.01) [Figure 1]. Children treated with NIV-NAVA had shorter median length of hospital [7 (5.5-8.8) days vs 12.9 (8-16.9) days; p<.001] and PICU [5.2(3.8-7.7) vs 11.7 (7.6-13.4) days p<.001] stay and similar PIM3 score [0.29 (0.21-0.91)% vs 0.30 (0.23-0.88)% p=.735] compared to intubated children.

Conclusions: Children on NIV-NAVA have shorter length of hospital and PICU stay compared to intubated children with similar PIM3 scores. NIV-NAVA can be considered a reasonable alternative to intubation in children with bronchiolitis and similar illness severity scores.
Figure 1: Rates of non-invasive neurally adjusted ventilatory assist mode of ventilation in children with bronchiolitis