Respiratory Support Escalation in Previously Healthy PICU Children With LRTIS: Causative Agents and Risk Factors.

Authors

Ayberk Özkavaklı, Ayşe Aşık, Muhterem Duyu

Published in

Pediatrics international : official journal of the Japan Pediatric Society. Volume 68. Issue 1.

Abstract

Lower respiratory tract infections (LRTIs) are a major cause of pediatric intensive care unit (PICU) admission. The association of microbiological etiology, including multiple-pathogen detection, with respiratory support escalation remains unclear. We evaluated factors associated with respiratory support escalation in previously healthy children with LRTIs.
This retrospective single-center study included previously healthy children aged 1 month-18 years admitted to a tertiary PICU with LRTIs between 2021 and 2026. Respiratory support escalation was defined as any transition to a higher level of support relative to the level at PICU admission. Factors associated with escalation and invasive mechanical ventilation (IMV) were evaluated using multivariable logistic regression.
Among 351 patients, median age was 15 months (IQR, 5-32) and 52.7% were male. Respiratory syncytial virus (21.0%) and Streptococcus pneumoniae (19.3%) were the most frequently detected pathogens. PCR-based multiple pathogens were detected in 23.6%, while no pathogen was identified in 29.9%. Respiratory support escalation occurred in 13.6%, and 9.1% required IMV. PRISM score was independently associated with escalation (aOR 1.074, 95% CI 1.031-1.118; p < 0.001) and IMV (aOR 1.383, 95% CI 1.263-1.514; p < 0.001). Female sex was associated with escalation (aOR 2.128, 95% CI 1.092-4.147; p = 0.026). Multiple-pathogen detection was associated with IMV in univariate analysis but not after adjustment.
Clinical severity was associated with respiratory support escalation and IMV, whereas independent associations with microbiological etiology were not demonstrated. Microbiological findings should therefore be interpreted alongside clinical severity when assessing respiratory support requirements.

PMID:
43016158
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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