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Mechanical ventilation drives inflammation in severe viral bronchiolitis

Marije P Hennus1, Adrianus J van Vught1, Mark Brabander1

  • 1Department of Paediatric Intensive Care, Wilhelmina Children's Hospital / University Medical Center Utrecht, Utrecht, The Netherlands.

Plos One
|December 19, 2013
PubMed

Insights

Mechanical ventilation in infants with respiratory syncytial virus (RSV) bronchiolitis significantly increases pulmonary inflammation. This study found elevated inflammatory mediators after intubation, suggesting ventilation itself, not just disease severity, drives this inflammation.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory viral infections
  • Immunology

Background:

  • Severe respiratory syncytial virus (RSV) infection is a leading cause of infant intensive care unit admissions.
  • Mechanically ventilated children with viral bronchiolitis show higher airway inflammatory mediators than spontaneously breathing ones.
  • Previous research indicated elevated inflammatory mediators in ventilated children, but the cause—disease severity versus mechanical ventilation—remained unclear.

Purpose of the Study:

  • To investigate whether elevated inflammatory mediators in infants with RSV bronchiolitis are linked to disease severity or mechanical ventilation.
  • To compare cytokine levels in mechanically ventilated infants versus non-ventilated controls.

Main Methods:

  • Prospective observational multi-center study.
  • Nasopharyngeal aspirates collected from 18 infants with RSV bronchiolitis requiring mechanical ventilation and 18 non-ventilated controls before intubation and 24 hours later.
  • Measured concentrations of interleukin (IL)-1α, IL-1β, IL-6, monocyte chemotactic protein (MCP)-1, and macrophage inflammatory protein (MIP)-1α.

Main Results:

  • Baseline cytokine levels were similar between ventilated and non-ventilated groups.
  • After 24 hours of mechanical ventilation, mean levels of IL-1α, IL-1β, IL-6, and MCP-1 were significantly elevated compared to non-ventilated controls.
  • MIP-1α levels did not show a significant difference between the groups after 24 hours.

Conclusions:

  • Mechanical ventilation and endotracheal intubation induce significant pulmonary inflammation in infants with RSV bronchiolitis.
  • The findings suggest that mechanical ventilation itself is a major contributor to increased pulmonary inflammation, beyond the initial disease severity.
Abstract

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