712: Risk Factors for Post-Extubation Stridor in Congenital Heart Surgical Patients

Abstract

INTRODUCTION:Asthma is a leading cause of pediatric hospitalization. Endotracheal intubation and invasive mechanical ventilation (IMV) in status asthmaticus (SA) are associated with increased complications and mortality. Recent practice trends favor non-invasive ventilation (NIV) to support respiratory failure in SA. Comparison of patients receiving IMV or NIV for SA can help predict which patients are at risk of intubation and poor outcomes. METHODS:This is a single center retrospective cohort study. The study period was from 2011-2020. Inclusion criteria were status asthmaticus and age 2-20 years. Patients who received invasive support were matched 1:2 with those receiving NIV by date of intubation. Data collected included demographics, past medical history, history of prior PICU stay, IMV or NIV use, home medications, environmental risk factors, asthma and non-asthma directed medical management, length of stay (LOS), complications, morbidity and mortality. Categorical data was compared using Chi square or Fisher's exact test as appropriate. T-tests were used to compare means.RESULTS: 49 patients received IMV for SA over a 10-year period and 98 patients who received NIV were identified as a control. There was no difference in gender, race, history of allergies, eczema, smoke exposure, pets, home medication or prior PICU stay. Intubated patients were 2.2 years older (p=0.02) and were more likely to have previously been intubated (18.4% vs 7.1%, p=0.04). Need for IMV was associated with a longer LOS (12.3d vs 5.4d, p< 0.01) as well as several complications, including pneumothorax, neuromyopathy, hypoxic ischemic encephalopathy, CPR and death. The groups had similar rates of pneumonia, which has previously been identified as a risk factor for intubation. Five patients (10.2%) died; all received IMV. 80% (n=4) of these patients had a pre-hospital arrest. None of the patients with mortality had previously been intubated. CONCLUSIONS:In this study, use of IMV was associated with older age and prior history of IMV. However, history of prior IMV was not associated with mortality. Pre-hospital arrest was a major driver of mortality. Efforts to reduce mortality in pediatric asthma may benefit from identifying high risk children in the community setting.