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Acute respiratory distress syndrome caused by respiratory syncytial virus
1Division of Pediatric Critical Care, Children's Hospital of Los Angeles, University of Southern California School of Medicine, USA.
Insights
Respiratory syncytial virus (RSV) can cause acute respiratory distress syndrome (ARDS) in infants. However, RSV-induced ARDS in children appears to have a better prognosis than previously thought, with most patients recovering well.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Infectious diseases
Background:
- Acute respiratory distress syndrome (ARDS) complicating severe respiratory syncytial virus (RSV) infection is rare in infants, with high reported mortality.
- Previous studies often group ARDS causes, hindering understanding of RSV-specific ARDS disease course.
- The clinical presentation and outcomes of RSV-induced ARDS in pediatric patients require further investigation.
Purpose of the Study:
- To investigate the pulmonary function abnormalities and clinical characteristics of infants with RSV-induced respiratory failure.
- To differentiate RSV-induced ARDS from obstructive RSV bronchiolitis in infants.
- To assess the outcomes and mortality associated with RSV-induced ARDS in a pediatric intensive care unit setting.
Main Methods:
- Retrospective analysis of 37 infants with RSV-induced respiratory failure requiring assisted ventilation.
- Pulmonary function tests including respiratory mechanics, maximum expiratory flow-volume curves, and lung volumes.
- Calculation of a modified Murray lung injury score incorporating radiographic findings, ventilator settings, lung compliance, and blood gas results.
Main Results:
- Ten infants met criteria for ARDS with severe restrictive lung disease (Murray score > 2.5).
- Twenty-seven infants presented with obstructive lung function consistent with RSV bronchiolitis.
- Infants with RSV-induced ARDS were younger, required longer ventilation, and had more predisposing illnesses compared to those with obstructive disease.
- Only one infant with immunodeficiency died; all others were managed successfully with conventional mechanical ventilation.
Conclusions:
- RSV-induced respiratory failure may represent a relatively benign cause of ARDS in pediatric patients.
- Differentiating ARDS by its specific cause, such as RSV, is crucial for accurate prognosis and therapeutic considerations.
- The findings suggest a better outcome for RSV-induced ARDS than previously reported, supporting individualized treatment strategies.
Abstract:
Acute respiratory distress syndrome (ARDS) complicating severe respiratory syncytial virus (RSV) infection has been described in only a few infants. In contrast to the low mortality rates usually associated with RSV infections (< 5%), mortality rates in the range of 40-70% have been reported in pediatric patients with ARDS. However, studies on patients with ARDS are usually lumped with respect to causation, and the disease course of RSV-induced ARDS has not been previously studied. We examined the pulmonary function abnormalities of 37 infants with RSV-induced respiratory failure who were admitted to our pediatric intensive care unit for assisted ventilation. Measurements included respiratory mechanics, maximum expiratory flow-volume curves, and lung volumes. These allowed the calculation of a Murray lung injury score (modified for pediatric use) in which radiographic findings, ventilator settings, lung compliance, and blood gas results were considered. We identified ten infants with severe restrictive lung disease who fulfilled the clinical criteria for classification as ARDS. All had lung injury scores above 2.5, compatible with a diagnosis of ARDS. Twenty-seven infants had obstructive patterns of lung function consistent with a clinical diagnosis of RSV bronchiolitis. The patients with RSV-induced ARDS were significantly younger, and had a longer time on assisted ventilation (P < 0.05) and a higher proportion of predisposing illnesses (P < 0.05, odds ratio = 6.67, two-tailed Fisher's exact test) when compared with the patients who had obstructive disease. Only one patient (who had immunodeficiency) died, and all others were successfully managed on conventional mechanical ventilation. We conclude that RSV-induced respiratory failure represents a relatively benign cause of ARDS in pediatric patients. Our observations support the notion of differentiating ARDS with respect to causation, especially when novel and experimental therapy is considered and mortality rates are analyzed.