Respiratory failure requiring ventilation in acute bronchiolitis.

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Medicine
• Neonatology

Background:

• Severe bronchiolitis can necessitate mechanical ventilation, posing risks like barotrauma.
• Mechanical ventilation is an uncommon but critical intervention for infants with severe respiratory distress.

Purpose of the Study:

• To report the experience and outcomes of infants with severe bronchiolitis requiring mechanical ventilation in a Paediatric Intensive Care Unit (PICU).
• To evaluate the efficacy and safety of mechanical ventilation in managing severe bronchiolitis.

Main Methods:

• Retrospective review of 60 infants admitted to the PICU with severe bronchiolitis.
• Analysis of data for the 25 (42%) infants who required mechanical ventilation.
• Assessment of oxygenation parameters (PaO2/FiO2), mean airway pressure, ventilation duration, and clinical outcomes.

Main Results:

• Mechanical ventilation was required in 42% of severe bronchiolitis cases admitted to the PICU.
• 18 patients (72%) experienced severe hypoxemia (PaO2/FiO2 < 250).
• Oxygenation improved significantly within 12 hours of intubation, with a median ventilation duration of 4.0 days and only one death.

Conclusions:

• Mechanical ventilation is an effective and generally well-tolerated treatment for a subset of infants with severe bronchiolitis.
• Early initiation of mechanical ventilation can lead to significant improvements in oxygenation.
• This intervention is associated with a low mortality rate in the context of severe pediatric respiratory illness.