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Respiratory failure and mechanical ventilation in severe bronchiolitis
M H Lebel1, M Gauthier, J Lacroix
1Paediatric Intensive Care Unit, Hôpital Sainte-Justine, University of Montreal, Canada.
Insights
Mechanical ventilation is safe for infants with severe bronchiolitis, particularly those who are younger, smaller, or premature. Prematurity is a key predictor for needing this intervention.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Critical Care
Background:
- Severe bronchiolitis often necessitates mechanical ventilation in infants.
- Identifying predictors for mechanical ventilation is crucial for timely intervention.
Purpose of the Study:
- To identify factors associated with the need for mechanical ventilation in infants with severe bronchiolitis.
- To assess the safety and outcomes of mechanical ventilation in this population.
Main Methods:
- Retrospective review of 62 infants requiring mechanical ventilation for severe bronchiolitis over 10 years.
- Comparison with 150 infants with bronchiolitis not requiring intensive care.
- Logistic regression analysis to determine predictors of ventilation need.
Main Results:
- Infants needing ventilation were younger, smaller, and more likely to be premature compared to controls.
- Infant weight, age, and prematurity were significant predictors; weight was most important.
- Mechanical ventilation duration was longer in infants with lower gestational age and family history of atopy.
- No deaths or complications like pneumothorax were observed.
Conclusions:
- Mechanical ventilation is a safe and well-tolerated treatment for severe bronchiolitis in infants.
- Prematurity is a significant predictor for requiring mechanical ventilation in severe bronchiolitis.
Abstract:
A retrospective review of children who needed mechanical ventilation for severe bronchiolitis identified 62 cases over a 10 year period. The mean age at initiation of ventilation was 73 days (range: 14-201). Compared with a group of 150 children in hospital for bronchiolitis but not transferred to the intensive care unit, these 62 cases were significantly younger (73.0 compared with 166.3 days), and smaller (4.5 compared with 6.8 kg), and significantly more had been born prematurely (40% compared with 16%). Taken independently, age, weight, and prematurity were significantly associated with the need for artificial ventilation, weight being the most important factor. Using stepwise logistic regression, prematurity in itself added to the quality of the prediction but age did not. The mean duration of mechanical ventilation was 105 hours (range 2-381). Duration of ventilation was significantly longer in children with a low gestational age at birth and a positive familial history of atopy. There were no deaths, and no patient developed pneumothorax or pneumomediastinum. Mechanical ventilation is well tolerated and safe in acute bronchiolitis.