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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
PubMed
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.

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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.

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