Risk factors for intubation in severe bronchiolitis: a useful tool to decide on an early intensive respiratory support

BACKGROUND: Bronchiolitis is the most frequent lower airway infection leading hospitalization in children younger than 2 years. RSV is the typical common cause, followed by rhinovirus. Criteria for Pediatric Intensive Care Unit (PICU) admission are not defined by guidelines. METHODS: A retrospective analysis of children with severe bronchiolitis admitted from 2013 to 2016 to our PICU was performed to identify the risk factors associated with intubation in this population. Fourteen variables were studied: sex, weight, age, nationality, provenience, duration of symptoms, risk factors for bronchiolitis development, recurrence, apnea, SpO2 in air, Modified Wood’s Clinical Asthma score (M-WCAS), microbiological results, medical treatment, CPAP therapy. The relationship between these variables and the need for mechanical ventilation were explored using univariate and multivariate logistic regression analysis. A ROC analysis was used to identify cut-off for the continuous variables identified as risk factors for intubation in multivariate analysis. RESULTS: We enrolled 93 patients: 19 of them (20.4%) were intubated. Univariate and multivariate analysis demonstrated that a M-WCAS Score ≥7, SpO2 ≤75% and apnea were significantly associated to intubation in children with severe bronchiolitis. CONCLUSIONS: Cut-off values of the variables identified as risk factors for intubation may represent an important tool for pediatricians to decide a prompt and appropriate intensive respiratory support.