Abstract
Background: Bronchiolitis may result in respiratory failure diagnosed with arterial blood gas (ABG). ABG is not routinely performed in general paediatric wards but is closely reflected by capillary blood gas (CBG). We sought to assess the usefulness of CBG results in prediction of intensive care unit (ICU) transfer, antibiotic treatment, and length of stay in children hospitalized due to bronchiolitis. Methods: The optimal cutoff values were estimated with an ROC analysis, while a multiple regression model calculated the odds of an ICU transfer, prolonged hospitalization, and antibiotic treatment related with hypercapnia (pCO2 ≥ 45 mmHg) and acidosis (pH ≤ 7.35). The correlation between the CBG (pH, pCO2, and SatO2) and the clinical/laboratory parameters (breath rate, heart rate, pulse oximetry, white blood cells, CRP, and procalcitonin) was calculated. Results: The CBG was performed in 485 children aged 8 days–22 months (median 2 months). The pCO2 was significantly higher in ICU transferred patients (median 44.8 mmHg vs. 36.2 mmHg, p < 0.01), and showed AUC = 0.773, (95% CI: 0.638–0.907, p < 0.01) for ICU transfer (67% sensitivity, 82% specificity, 10.8% positive and 98.7% negative predictive value at cutoff 41.8 mmHg). Hypercapnia (OR = 6.63, 95% CI: 2.15–20.46, p < 0.01) and acidosis (OR = 5.01, 95% CI: 1.26–19.9, p = 0.022) predicted the ICU transfer independently. The CBG parameters were not related to prolonged hospitalization or antibiotic treatment, and showed only a weak and clinically irrelevant correlation with other laboratory and clinical parameters. Conclusions: Acidosis and hypercapnia indicate patients at risk of an ICU transfer, and the pCO2 levels (including values lower than hypercapnia) seem to be a promising marker in ICU risk assessment.
Highlights
Bronchiolitis is an inflammatory process defined as the first episode of wheezing in children under 24 months of age and is a major single cause of paediatric hospitalizations in infants [1]
A correlation between the arterial and capillary blood gas has been shown in several studies; the studies were set in intensive care units [7,9,10], the results may be extended to the group of children hospitalized because of bronchiolitis, since one of the most important risks related to bronchiolitis is respiratory failure and an ICU transfer
Our study showed that the capillary blood gas (CBG), especially the pCO2, may be a useful tool in predicting the risk of an ICU transfer
Summary
Bronchiolitis is an inflammatory process defined as the first episode of wheezing in children under 24 months of age and is a major single cause of paediatric hospitalizations in infants [1]. A correlation between the arterial and capillary blood gas has been shown in several studies; the studies were set in intensive care units [7,9,10], the results may be extended to the group of children hospitalized because of bronchiolitis, since one of the most important risks related to bronchiolitis is respiratory failure and an ICU transfer. The British National Institute for Health and Care Excellence (NICE) guidelines on the management of bronchiolitis advise that capillary blood gas may be considered in patients who deteriorate severely or are at an impending risk of respiratory failure [11]. We sought to assess the usefulness of CBG results in prediction of intensive care unit (ICU) transfer, antibiotic treatment, and length of stay in children hospitalized due to bronchiolitis. Conclusions: Acidosis and hypercapnia indicate patients at risk of an ICU transfer, and the pCO2 levels (including values lower than hypercapnia) seem to be a promising marker in ICU risk assessment
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