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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
Insights
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.
Objective:
To determine whether previously well infants ventilated for bronchiolitis have sufficiently elevated pulmonary artery pressures (PAP) to warrant a trial of inhaled nitric oxide (iNO) therapy.
Methods:
Consecutive infants mechanically ventilated for bronchiolitis were offered Doppler echocardiography between 24 and 72 h after intubation. Patients were divided into those with normal PAP, mild, moderate or severe pulmonary hypertension. Patients with at least moderate pulmonary hypertension (systolic PAP > 30 mmHg and > 50% of systemic systolic arterial pressure) were offered a 60 min trial of iNO therapy at a concentration of 20 ppm and repeat echocardiography.
Results:
Six infants (four preterm, two term) were studied at a mean corrected age of 13 weeks (4, 24). Respiratory syncytial virus was confirmed on immunofluorescence of nasal secretions in five of six subjects (84%). Echocardiography was performed (mean, 5.5 days) (95%CI 3.8-7.3) after the onset of symptoms. All patients had structurally normal hearts. Four patients had mild pulmonary artery hypertension and two had normal pulmonary artery pressures. None of the patients qualified for iNO therapy. The mean (range) duration of intubation was 14 days (9-19) and the duration of hospitalization was 28 days (14-42). All patients recovered.
Conclusion:
Significant pulmonary hypertension should not be presumed in previously well preterm and term infants ventilated for bronchiolitis.