Outcomes of noninvasive versus invasive respiratory support in pediatric scrub typhus-associated acute respiratory failure: a retrospective cohort study from South India

Scrub typhus is an important cause of acute febrile illness in children that may progress to acute respiratory failure (ARF). However, evidence for noninvasive respiratory support (NIRS) in this setting is limited. The main objective of this study is to compare outcomes of NIRS versus invasive mechanical ventilation (IMV) in pediatric scrub typhus-related ARF and identify predictors of NIV failure. This study included children aged 28 days-15 years with confirmed scrub typhus and ARF who were admitted to the pediatric critical care unit of a tertiary center in South India. Patients were classified according to the type of respiratory support in the first 4 h (NIRS: heated humidified high-flow nasal cannula [HHHFNC] and/or noninvasive ventilation [NIV]; or IMV). Clinical and laboratory data and outcomes were analyzed. The predictors of NIV failure were evaluated in a subgroup of NIV recipients. Of the 160 children, 46 (28.8%) received HHHFNC, 52 (32.5%) NIV, and 62 (38.7%) IMV as initial support. Eighteen NIV patients (34.6%) required intubation and were analysed with the IMV group (IMV n=80, NIRS n=80). The overall survival was 67.5%, higher with NIRS than IMV (96.3% vs 38.7%, P<.001). NIV failure occurred in 22.5% of patients and was associated with a mortality rate of 66.7%. Younger age, male sex, facial puffiness, hepatomegaly, thrombocytopenia, elevated lactate levels, and higher SOFA, PIM2, and VIS scores predicted NIV failure (P<.05). The duration of respiratory support, ICU stay, and inotrope use were greater with IMV. NIRS is effective and is associated with better survival in children with scrub typhus ARDS. Vigilant monitoring and early escalation in high-risk patients may improve outcomes.