Respiratory failure complicating rubeola

We reviewed the charts of 19 patients with the diagnosis of measles who were admitted to the pediatric intensive care unit for respiratory failure requiring intubation and mechanical ventilation. Patients studied were admitted during the period June 1989 to June 1990. The mean age was 19 months (range, 3 to 51 months). The cause for respiratory failure fell into two groups: 47 percent developed pneumonitis and refractory hypoxemia. Patients with pneumonitis and hypoxemic respiratory failure had a 56 percent mortality. An oxygenation index of greater than 40 for 4 h separated survivors from nonsurvivors (oxygenation index = [mean airway pressure x FIo2/PaO2 x 100]). Patients with tracheitis alone all survived. In these patients the organism primarily responsible was Staphylococcus aureus (70 percent). Two of the seven patients with S aureus tracheitis had signs and symptoms of toxic shock syndrome and we subsequently demonstrated toxic shock syndrome toxin 1 in both patients.