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V Varnholt1, P Lasch1, G Suske1

  • 1Universitäts-Kinderklinik Mannheim, , , , XX.

Monatsschrift Kinderheilkunde : Organ Der Deutschen Gesellschaft Fur Kinderheilkunde
|April 1, 2020
PubMed
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Severe respiratory syncytial virus (RSV) infections in former preterm infants can be life-threatening. Advanced treatments like inhaled nitric oxide (NO), high-frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation (ECMO) offer hope for survival.

Area of Science:

  • Neonatal care
  • Pediatric critical care
  • Respiratory medicine

Context:

  • A notable increase in referrals of former preterm infants with respiratory syncytial virus (RSV) infection and subsequent acute respiratory distress syndrome (ARDS) was observed.
  • Previous treatments including inhalational ribavirin, bronchodilators, and surfactant instillation were unsuccessful.

Purpose:

  • To evaluate the clinical course and outcomes of severe RSV infections in former preterm infants treated with advanced respiratory support modalities.
  • To assess the efficacy of inhaled nitric oxide (NO), high-frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation (ECMO) in managing severe RSV-induced ARDS.

Summary:

  • Ten infants (1-43 months) with severe RSV infection and ARDS required mechanical ventilation (mean 6.6 days) with high oxygen and pressure support.
Keywords:
ARDSExtracorporeal membrane oxygenation (ECMO)High frequency oscillatory ventilation (HFOV)Inhaled nitric oxide (NO)Key words Respiratory syncytial virus (RSV)

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  • Four patients stabilized with inhaled NO and either IPPV or HFOV; six required ECMO, with two fatalities despite prolonged support.
  • Eight survivors were discharged after a mean hospital stay of 3 months, indicating the potential success of advanced therapies.

    • Impact:

    • Inhaled NO, HFOV, and ECMO can be successfully employed in managing extremely severe cases of RSV infection.
    • These advanced treatments should be considered before lung damage becomes irreversible.
    • Pre-existing bronchopulmonary dysplasia (BPD) is not a contraindication for extracorporeal lung support in these critical cases.