Predictors of prolonged length of stay in PICU of infants with severe bronchiolitis: are initial blood gases helpful?

Abstract Purpose Every year between November and January, the epidemic of acute viral bronchiolitis causes massive admissions to pediatric intensive care units. One of the challenges is to identify infants who will require invasive ventilation or have a prolonged length of stay in intensive care units. Methods We conducted a multicenter retrospective study on three PICU wards in France to evaluate the different risk factors for prolonged hospitalization in pediatric intensive care and for invasive ventilation. We focused particularly on the blood gas parameters (pH, PCO2, and bicarbonate) before and after PICU admission. Results We included 268 patients between October 2018 and April 2019. Mean age was 62 days, 7% of infants had chronic conditions (bronchopulmonary dysplasia, congenital heart disease, etc.). The median length of stay in PICU was 4 days, 83% of infants required noninvasive ventilation and 6% required invasive ventilation. Variables associated with prolonged length of stay in PICU were an age less than 30 days, a severe comorbidity, onset of symptoms less than 3 days before admission, initial FiO2 above 30%, presence of apneas or bradycardia, hemodynamic failure, and presence of bacterial coinfection. The pH, PCO2 and bicarbonate after PICU admission were correlated with PICU length of stay whereas none of the blood gas parameters before admission. Conclusion Blood gas after PICU admission may be useful to predict the length of stay in PICU in patients whose clinical condition is difficult to evaluate.