Disclosures: Aaron J. Charnay, MD: Nothing to disclose

Objective: Identify common factors that were used to determine appropriateness of botulinum toxin injection to salivary glands of pediatric patients with sialorrhea and an underlying neuromuscular disorder who were admitted to the intensive care unit for respiratory distress.

Design: Retrospective chart review.

Setting: PICU of a single tertiary care children’s hospital.

Participants: Between 2011 and 2018, a total of 36 evaluations were performed among 22 patients who met strict inclusion criteria. Evaluations were performed by pediatric rehabilitation specialists as part of clinical management.

Interventions: Not Applicable.

Main Outcome Measures: Demographics, dates/notes of rehabilitation evaluation and botulinum administration (if given), clinical factors at time of evaluation: respiratory status, vitals, medications.

Results: Ages ranged from 4 months to 19 years. Half were female. Of 36 evaluations performed, 11 resulted in botulinum administration. 9 patients were evaluated more than once during hospitalization, 3 of whom were initially deemed inappropriate for injections but appropriate on re-evaluation later in hospitalization. Among the 25 evaluations resulting in no botulinum, 12 independent factors were identified as indications to abstain. These fit broadly into three categories: medical instability (10), logistical (9), medically unnecessary (6). Chi-square analysis between groups (botulinum received vs no botulinum received) showed no significant differences in patients who were on antibiotics, had tracheostomy, or were recently febrile. Recipients were more likely to be on anticoagulation (P<.05). At time of evaluation, both groups had a respiratory status that was escalated from their baseline, but a majority were not intubated.

Conclusions: Medical instability remained the most common reason to abstain from salivary gland botulinum injection in this group of patients, though notably, the use of treatment antibiotics, anticoagulation, escalated respiratory support, and recent fever were not reasons to withhold. These findings are an initial step in identifying objective data to help providers determine the appropriateness of botulinum toxin injections in critically ill patients.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rationale-in-giving-salivary-gland-botulinum-toxin-injections-to-children-in-the-pediatric-intensive-care-unit-a-single-center-retrospective-study/