Epidemiology and outcomes of critically ill children with viral infections requiring admission to a pediatric intensive care unit

Abstract

Aims & Objectives: Few contemporary cohorts characterize the impact of viral infections on critically ill children. We investigated epidemiology and outcomes of confirmed viral infections in children admitted to a Pediatric Intensive Care Unit (PICU). Methods Multicenter retrospective study including children <16 years non-electively admitted to PICU from January 1st 2008 until December 31st 2013. Testing was performed in symptomatic patients using an extended panel Polymerase Chain Reaction (PCR), capturing nine respiratory viruses. Patients were defined as virus positive on admission if the PCR result was positive between 72hrs prior to and 48hrs after PICU admission. Primary outcomes were PICU length of stay (LOS), duration of intubation and total duration of respiratory support (invasive and non-invasive). Results Of 6,426 non-elective admissions, 1,353 (21%) patients were virus positive. In comparison to negative/untested patients, virus positive patients had longer respiratory support duration (median 51 versus 34 hours, p<0.001), were more likely to require prolonged intubation (adjusted OR 1.5; 95%-CI 1.2-1.8, p=0.001) and high-frequency oscillatory ventilation (adjusted OR 2.6; 1.9-3.7; p<0.001), and had increased PICU LOS (median 2.1 versus 1.4 days, p<0.001). Similar findings were observed when restricting analyses to patients with acute respiratory infections (p<0.05). Adjusted mortality was comparable in multivariate analyses within the entire group, acute respiratory infections, and patients with sepsis when comparing virus positive with negative/untested patients (p>0.1). Conclusions Viral infections are common in critically ill children. The significant morbidity translates into a substantial burden for PICU healthcare systems. Research into effective antiviral agents and integrated vaccines for viral pathogens is needed.L6238157772018-09-13 <br />