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Artificial ventilation in severe pertussis
J Gillis1, T Grattan-Smith, H Kilham
1Intensive Care Unit, Children's Hospital, Camperdown, Sydney, Australia.
Insights
Early intubation and ventilation in severe pertussis (whooping cough) can be safely used in infants. This intervention may prevent hypoxic damage and death, especially in those under 3 months old.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Pertussis (whooping cough) remains a significant cause of respiratory illness in infants.
- Severe pertussis can lead to respiratory failure requiring intensive care.
Purpose of the Study:
- To evaluate the outcomes of intubation and mechanical ventilation in infants with culture-proven pertussis admitted to the intensive care unit.
- To determine the safety and efficacy of early ventilatory support in severe pertussis.
Main Methods:
- Retrospective review of pediatric intensive care unit admissions over eight years.
- Analysis of patients diagnosed with culture-proven pertussis.
- Evaluation of ventilatory support, intubation indications, and patient outcomes.
Main Results:
- Twenty-four of 789 children with pertussis required intensive care; 13 needed ventilatory support.
- Ventilation was initiated primarily for significant apnea, mainly in infants under 3 months old within 16 days of cough onset.
- Ventilation was generally not difficult or prolonged, and coughing spasms were not problematic. Severe bacterial pneumonia indicated a poor prognosis.
Conclusions:
- Intubation and ventilation can be safely employed in very severe pertussis infections.
- Early ventilatory support should not be a last resort for critically ill infants due to the high risk of hypoxic damage and mortality.
Abstract:
A retrospective review was conducted of all children admitted to our intensive care unit over eight years with a diagnosis of pertussis that had been proved on culture. Altogether 789 children were seen as outpatients and inpatients. Twenty four of these children were admitted to the intensive care unit, 13 of whom required ventilatory support; two of the ventilated patients died. Intubation and ventilation were usually started for appreciable apnoea. Most patients requiring support were less than 3 months of age and required intervention within the first 16 days of cough. For these patients ventilation was neither difficult nor prolonged. Coughing spasms were not a problem and intubation and ventilation appeared to attenuate the progress of the disease. The presence of severe bacterial pneumonia associated with difficult ventilation requiring neuromuscular paralysis indicated a poor prognosis. It is suggested that intubation and ventilation can be safely used in very severe pertussis infection and, because of their greater risk of hypoxic damage and death, it should not be reserved as a last resort in critically ill infants.