Predictors of invasive mechanical ventilation in children with severe COVID-19

Abstract

Background: To compare the demographic characteristics, clinical symptoms, laboratory findings, and comorbidities of hospitalized children with the Coronavirus disease (COVID-19) who required invasive mechanical ventilation (IMV) and analyse them to find out potential predictors for requirement of mechanical ventilation. Methods: Study design was of single centre, retrospective record review. Settings were tertiary care hospital in New Delhi, India, between April, 2020 to October, 2020 Results: 100-laboratory confirmed COVID-19 cases were admitted during the study period. Thirty-five patients required IMV. Median age of ventilated patients was 65 (10.5, 126) months and median weight was 15 (8.5, 23.3) kg. Forty-three percent (43%) of patients were underweight (p=0.46) while 40% had chronic co-morbidity (p=0.015). Gastrointestinal symptoms (p<0.05), altered sensorium at presentation (p<0.001) and hypoxia at admission (p<0.00) were significantly greater in those who required ventilation. A statistically significant difference was also noted in inflammatory markers between ventilated and non-ventilated patients. Acute kidney injury (p=0.003) and transaminitis (p=0.05) at admission were 26 and 32% respectively in ventilated patients. The most common indicators for ventilation need were primary respiratory disease (35%) followed by shock (31%) and low Glasgow coma scale (23%). Nearly 70% of these were intubated within 48 hours of hospital admission. Multivariate analysis highlighted that presence of low SpO2 at admission (adjusted OR, 6.9; 95% CI, 1.3-36.6) was significantly associated with need of IMV. Conclusions: Study highlights important characteristics of paediatric population from developing country with COVID-19 who required IMV. Presence of low oxygen saturation at admission significantly associated with need of IMV.