Role of ventilation in RSV disease: CPAP, ventilation, HFO, ECMO

Respiratory syncytial virus (RSV) lower respiratory tract disease may present as bronchiolitis, an obstructive lung disease with hyperinflation, or pneumonitis, a restrictive parenchymal disease with diffuse consolidation, a large intrapulmonary shunt and acute respiratory distress syndrome (ARDS). Although a significant proportion of those admitted to hospital will require some form of respiratory support, there have been few randomised studies to determine which is the most beneficial. Studies on the use of continuous positive airway pressure (CPAP), heliox, inhaled nitric oxide, and natural surfactant are reviewed. Current practice regarding ventilator support is largely based on clinical judgment and case reports. Multicentre randomised trials with long-term follow-ups are urgently required.