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Respiratory failure complicating rubeola
J D Swift1, M C Barruga, R M Perkin
1Department of Pediatrics, Loma Linda University Medical Center, Calif.
Chest
|December 1, 1993
Summary
Measles can cause severe respiratory failure in children requiring intensive care. Pneumonitis and hypoxemia led to high mortality, while tracheitis had a better prognosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Measles is a highly contagious viral illness.
- Respiratory complications, including failure requiring mechanical ventilation, can occur in severe measles cases.
- Pediatric intensive care unit (PICU) admissions for measles-related respiratory failure present unique challenges.
Purpose of the Study:
- To analyze the characteristics and outcomes of pediatric patients admitted to the PICU for measles-induced respiratory failure.
- To identify factors associated with mortality in these critically ill children.
- To investigate the role of specific pathogens and syndromes in measles-related respiratory complications.
Main Methods:
- Retrospective chart review of 19 patients admitted to the PICU with measles and respiratory failure requiring intubation and mechanical ventilation between June 1989 and June 1990.
- Categorization of respiratory failure causes into pneumonitis/hypoxemia and tracheitis.
- Calculation of the oxygenation index to assess respiratory support needs and outcomes.
- Microbiological investigation for Staphylococcus aureus and toxic shock syndrome toxin 1 in patients with tracheitis.
Main Results:
- 47% of patients developed pneumonitis and refractory hypoxemia, with a 56% mortality rate in this subgroup.
- An oxygenation index greater than 40 for 4 hours was a predictor of mortality.
- All patients with tracheitis alone survived.
- Staphylococcus aureus was the primary pathogen in tracheitis cases (70%).
- Two patients with S. aureus tracheitis exhibited toxic shock syndrome, confirmed by the presence of toxic shock syndrome toxin 1.
Conclusions:
- Measles-induced pneumonitis and hypoxemia requiring mechanical ventilation carry a significant mortality risk in the pediatric intensive care setting.
- The oxygenation index can serve as a prognostic indicator for severe measles-related respiratory failure.
- Tracheitis as a complication of measles, particularly when caused by Staphylococcus aureus, appears to have a better prognosis, though toxic shock syndrome is a potential severe complication.