325: CHILDREN UNDER 24 MONTHS REQUIRE LESS SEDATION ON NIV WHEN FED

Abstract

Introduction: In the PICU population, enteral nutrition (EN) as well as dexmedetomidine have been described as safe and effective with dexmedetomidine as the primary sedative of choice to improve tolerance of NIV. Methods to increase tolerance of NIV interfaces have been particularly important for patients < 24 months. We aimed to describe the potential association of EN with dexmedetomidine requirements for children on NIV. Here we describe a secondary aim to determine if there is a more pronounced association in the < 24 month population versus older children. Methods: A retrospective chart review was conducted of all children in our PICU acutely supported with NIV for at least 12 hours for a one-year period from April 1, 2019 - March 31, 2020. Data was collected until subjects were transferred out of the PICU, weaned off NIV, required intubation, or completed a max of 7 study days; whichever came first. Statistical comparisons were made using t-tests and chi-square tests for continuous and categorical variables, respectively. Results: 289 subjects were enrolled. 196 were < 24 months and 93 were older. On day 0, there were statistically significant differences (α = 0.05, p-value < 0.05) in the amount of children who received dexmedetomidine and were not fed and those who were fed in the < 24 month (50.7% versus 13.2%) and >25 month group (30.8% versus 11.1%). This continued for the younger group on day 1 with 69% not fed receiving dexmedetomidine versus 27.5% who were fed but lost its association for the older group past day 0. Conclusions: For critically ill children supported with NIV, there was a significant association with requirement of dexmedetomidine for patients who were not fed on day of initiation of NIV as previously presented. In this age-based subgroup analysis, this association was greater in the < 24 month age group than older children, supporting that feeding can potentially decrease sedation need even in this notoriously NIV intolerant group.