(818) Effectiveness of Medications to Treat Bronchiolitis in the PICU

Introduction: Bronchiolitis is a leading cause of PICU admissions; however, there is limited research into the effectiveness of therapies used to treat bronchiolitis. We aim to identify associations between the use of bronchodilators, steroids, inhaled 3% saline (HTS), inhaled n-acetylcysteine (NAC) and dornase-alfa (DA) with PICU length of stay (LOS), rate of intubation, and duration of intubation.

Methods: We conducted a cohort study using Pediatric Health Information System (PHIS) data for patients admitted to a PICU with bronchiolitis between 7/1/2018-6/30/2022. We defined exposure as  2 doses of a medication while in the PICU. Bronchodilators included albuterol and levalbuterol. Steroids included prednisone, prednisolone, methylprednisolone, and dexamethasone. We dichotomized duration of intubation using PHIS coding of intubation as < or  96 hours. Generalized estimating equations (GEE) with logistic and negative binomial regression estimated medication effects while controlling for patient demographics, comorbidities, All Patient Refined Diagnostic Related Group severity of illness, and hospital site. Estimates for medication effects on LOS also controlled for tracheostomy and mechanical ventilation. Estimates of medication effects are expressed as Incidence rate ratio (IRR) with 95% Confidence Intervals (CI) for LOS and Odds Ratios (OR) for rates of intubation and intubation  96 hours.

Results: We analyzed 47,520 hospitalizations, including 1,515 hospitalizations with intubation. Longer LOS was associated with bronchodilators (IRR 1.15, 95%CI 1.08-1.23), steroids (1.3, 1.3-1.4), HTS (1.4, 1.3-1.5), NAC (1.4, 1.2-1.6), and DA (1.6, 1.5-1.9). Intubation was associated with steroids (OR 7.6, 95%CI 5.4-10.6), HTS (1.9, 1.4-2.7), NAC (3.5, 2.2-5.5), and DA (7, 2.5-19.6), but not bronchodilators (0.8, 0.6-1.0). Intubation > 96 hours was associated with bronchodilators (OR 1.9, 95%CI 1.4-2.5), HTS (2.3, 1.6-3.1), NAC (2.9, 1.9-4.6), DA (2.4, 1.5-3.8), but not steroids (1.2, 0.9-1.5).

Conclusions: Use of bronchodilators, steroids, HTS, NAC, or DA to treat patients with bronchiolitis in the PICU is not associated with reduced PICU LOS, rate of intubation, or duration of intubation. Additional study with more granular severity of illness scores and timing of therapies is needed to verify our results.