OP-080 Infectious acute respiratory failure in patients under five years of age

AimAcute lower respiratory infections in children under five years old present a real challenge for diagnosis and treatment and a leading cause of mortality. The study aimed to describe this population at admission to the pediatric intensive care unit and during hospitalization to better identify their needs. Secondary outcomes consisted of comparing patients aged less and more than six months, and the presence or absence of an alveolar condensation on chest X-ray or lung ultrasound.Material and MethodWe conducted a retrospective, multicenter study in two pediatric intensive care units in the Ile-de-France region. We included children under five years of age hospitalized between January 1st,2017, and December 31st, 2021 for a respiratory infection complicated by acute respiratory failure (figure 1).Abstract OP-080 Figure 1Flow chart.ResultsWe included 707 patients. The mean age was 9 months. On arrival, patients were oxygen-dependent with a mean FiO2 of 34%, and 63% required non-invasive ventilation (NIV). During hospitalization, more than 70% required ventilatory support by NIV, and 10% tracheal intubation. 18% required volemic expansion, and 4% vasopressors. Nearly 90% of PCRs for respiratory viruses were positive, and in almost two-thirds of cases, RSV was found. S.pneumoniae, M.catarrhalis, and H.influenzae were frequently found. Significantly, patients aged less than six months needed NIV more, had less alveolar condensation, had slightly lower oxygen requirements, a less frank inflammatory syndrome, a more frequently positive PCR for respiratory viruses, were less frequently treated with antibiotics, but when they were, required a longer duration of treatment.ConclusionsWe showed similarities between patients hospitalized for lower respiratory infection in pediatric intensive care units in France and those in Australia or Brazil. Optimal management relies mainly on NIV, oxygen therapy with FiO2 under 40%, and available antibiotics. These results lead us to believe that the implementation of NIV training and equipment could help reduce mortality from lower respiratory infections in children worldwide.