(878) Continuous Vaporized L-Epinephrine for Children With Bronchiolitis

Introduction: Viral bronchiolitis is the most common nonelective admission to pediatric intensive care units (ICU). Medications have not shown benefit and treatment of bronchiolitis is focused on supportive care. However, some evidence suggests that continuous inhalation of epinephrine may decrease lower airways resistance and work of breathing. Our institution has used continuous vaporized L-epinephrine (CVE) for the past ten years as rescue therapy for patients with bronchiolitis. We aim to compare the demographics, clinical features, and outcomes of patients with bronchiolitis who did and did not receive CVE.

Methods: Single center cohort study of children < 2 years old admitted to the pediatric ICU with bronchiolitis from 2017 to 2023. Patients were identified by STAR code in Virtual Pediatric Systems and confirmed in our institutional database. Demographic and clinical features and respiratory procedures were abstracted. Exposure to and duration of CVE was obtained from the electronic medical record. Physician notes identified indication for the medication. The demographic and clinical features and outcomes were compared between children who received CVE and those who did not. P-values were obtained from the chi-square test for categorical variables, two-sample Student T-test for continuous variables with normal distribution, and two-sample Mann-Whitney U test for continuous variables with non-normal distribution.

Results: 436 patients met our cohort definition; 78 of them (17.8%) were treated with CVE. Those who received CVE, compared to those who did not, were younger (median age: 5 vs 9 months, p < 0.01) and smaller (median weight: 6.9 vs 8 kg, p < 0.01). Their peak respiratory rate from the 1st 12 hours was higher (median: 67.5 vs 57 bpm, p< 0.001). They had longer ICU length of stay (3.7 days vs 2.1 days, p< 0.001). The CVE group had non-statistically significant higher PRISM3 scores (56% vs 38%, p=0.51).

Conclusions: CVE is a novel therapy for critical bronchiolitis patients and is being used at our institution for younger and smaller patients with higher respiratory rate. Our next step is to use propensity score matching on bronchiolitis children to quantify the impact of CVE on clinical outcomes.