(879) Oral Nutrition During Continuous Albuterol for Pediatric Critical Asthma: A Matched Cohort Study

Introduction: The practice of withholding by mouth enteral nutrition (EN) for children hospitalized for critical asthma (CA) receiving continuous albuterol is not evidence based and largely driven by provider perceptions regarding the risk of dysphagia and aspiration-related respiratory failure (ARRF). We sought to characterize EN practices for pediatric CA and estimate the frequency of ARRF.

Methods: We performed a single-center retrospective, matched cohort study of children 3 - 17 years of age admitted to a pediatric intensive care unit (PICU) from Oct 2020 – May 2023 for CA on continuous albuterol. Cases provided EN were matched 2:1 by age ± 1 year and National Heart Lung Blood Institute [NHLBI] asthma severity classification to controls withheld EN. The primary outcome was ARRF defined as intubation or escalation of support after an observed aspiration. Descriptive data included demographics, anthropometrics, pediatric asthma severity scores [PASS], adjunctive CA therapies (e.g., high-flow nasal cannula [HFNC], bilevel positive airway pressure [BIPAP], mechanical ventilation [MV], aminophylline, terbutaline, etc.), continuous albuterol duration, and general PICU outcomes (e.g., mortality, length of stay [LOS]). Comparisons between cases and controls were made using Wilcoxon matched-pairs signed-rank and chi-square tests.

Results: We identified 33 cases and 66 matched controls. The mean age of 9.1 ± 3.9 years and 66.7% had moderate to severe persistent NHLBI asthma. Cases and controls had comparable anthropometric measurements (i.e., BMI-for-age and weight-for-age z¬-scores) and admission PASS values (median of 12 [IQR:10,13]). Cases were permitted EN by mouth, ad lib, and regular for age diet with 24.2% fed concurrently with HFNC and 36.4% BiPAP. No ARRF events were observed for cases and controls. Compared to controls, cases experienced a longer duration of continuous albuterol (median of 1.1 [IQR: 0.7,1.8] vs 0.7 [IQR:0.3,1.3] days, p< 0.001). No detectable differences were observed for exposure to adjunctive CA therapies, MV rate, mortality rate, or LOS.

Conclusions: In this matched cohort study, the provision of EN during continuous albuterol for pediatric CA was well tolerated. While prospective validation studies are needed, the practice of withholding EN in this population may be unwarranted.