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Intensive care course and outcome of patients infected with respiratory syncytial virus
M Stretton1, S J Ajizian, I Mitchell
1Division of Pediatric Intensive Care, Children's Hospital of Los Angeles, CA 90027.
Insights
Respiratory syncytial virus (RSV) infection in infants often requires mechanical ventilation, especially in those with underlying health conditions. Early intervention is crucial for better outcomes in previously healthy, RSV-infected infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Respiratory syncytial virus (RSV) is a common cause of respiratory illness in infants.
- Pre-existing pulmonary or cardiac conditions increase the risk of severe RSV infection requiring intensive care.
Purpose of the Study:
- To analyze the characteristics and outcomes of pediatric intensive care unit (PICU) admissions for RSV infection.
- To identify risk factors for mechanical ventilation and mortality in infants with RSV.
Main Methods:
- Retrospective review of 97 children admitted to the PICU with RSV infection.
- Comparison of clinical data between ventilated and non-ventilated patients, and between groups with and without preceding disease.
- Analysis of factors influencing ventilation duration, length of stay, and mortality.
Main Results:
- 68% of previously healthy infants and 79% of those with underlying diseases required mechanical ventilation.
- Ventilated infants were younger and had lower birth weights, particularly those ventilated for apnea.
- Infants with cardiac disease required longer ventilation periods, and immunocompromised patients faced the highest mortality risk.
Conclusions:
- Mechanical ventilation is a safe and effective treatment for previously healthy infants with RSV infection.
- Early initiation of mechanical ventilation is recommended before significant cardiorespiratory compromise develops.
- Underlying health conditions, especially cardiac disease and immunocompromise, are significant risk factors for severe outcomes in RSV infection.
Abstract:
PICU admissions of 97 children positive for respiratory syncytial virus on fluorescent antibody screening were reviewed; 68% of 44 patients without history of preceding disease (Group I) and 79% of 53 patients with preceding pulmonary, cardiac, or other disease (Group II) required ventilation. In Group I ventilated children weighted significantly less (P = 0.001) and were of lower chronological (P = 0.02) and post-conceptional ages (P = 0.02) than those not ventilated. Eighteen infants ventilated for apnea weighted significantly less (P = 0.003), were more often born at less than or equal to 37 weeks gestation (P = 0.001) and were at lower post-conceptional age than 11 infants ventilated for progressive respiratory deterioration. There was no significant difference in mean weight, chronological age, post-conceptional age, CO2, or pH between 12 admissions with BPD who required ventilation for RSV infection and 5 who did not require ventilation. Ribavirin administration to five ventilated patients with BPD did not significantly alter the duration of intubation of PICU stay. Six patients with cardiac disease required longer periods of ventilation than others (Group I, P = 0.001; all others in Group II, P = 0.04). No deaths occurred in Group I, while 6 of 53 (11%) patients in Group II died. In this series immuno compromise placed patients at greatest risk of dying. Mechanical ventilation can be safely managed in previously healthy, RSV infected infants and should be initiated before significant cardiorespiratory compromise arises.