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Quantifying pulmonary hypertension in ventilated infants with bronchiolitis: a pilot study
D Fitzgerald1, G M Davis, C Rohlicek
1Department of Respiratory Medicine, Montreal Children's Hospital Research Institute, Montreal Children's Hospital, Montreal, Quebec, Canada. dominif2@nch.edu.au
Journal of Paediatrics and Child Health
|February 13, 2001
Summary
Previously well infants with bronchiolitis requiring mechanical ventilation rarely have pulmonary hypertension. Therefore, a trial of inhaled nitric oxide (iNO) therapy is not typically warranted for these patients.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Pediatric Cardiology
Background:
- Bronchiolitis is a common respiratory illness in infants, often requiring mechanical ventilation.
- Pulmonary hypertension (PH) is a potential complication of severe respiratory illness in infants.
- Inhaled nitric oxide (iNO) therapy is used to treat PH in certain pediatric populations.
Purpose of the Study:
- To assess the prevalence of pulmonary artery pressures (PAP) in infants ventilated for bronchiolitis.
- To determine if PAP levels warrant inhaled nitric oxide (iNO) therapy in this patient group.
Main Methods:
- Doppler echocardiography was performed on infants mechanically ventilated for bronchiolitis within 72 hours of intubation.
- Patients were categorized based on pulmonary hypertension severity.
- A trial of iNO was offered to patients with at least moderate pulmonary hypertension.
Main Results:
- Six infants (four preterm, two term) were studied.
- Respiratory syncytial virus was confirmed in 84% of subjects.
- All infants had structurally normal hearts.
- Four patients had mild PH, and two had normal PAP.
- No patients met criteria for iNO therapy.
- Mean intubation duration was 14 days, and hospitalization was 28 days.
Conclusions:
- Significant pulmonary hypertension is uncommon in previously well infants ventilated for bronchiolitis.
- Routine iNO therapy is not indicated for this patient population based on PAP levels.