Chest radiological patterns predict the duration of mechanical ventilation in children with RSV infection
Parthak Prodhan & Sjirk J. Westra & James Lin & Sarit Karni-Sharoor & Susan Regan & Natan Noviski
Received: 11 July 2008 / Revised: 19 September 2008 / Accepted: 3 October 2008 / Published online: 8November 2008 # Springer-Verlag 2008
Abstract Background RSV-infected children demonstrate various radiographic features, some of which are associated with worse clinical outcomes. Objective To investigate whether specific chest radiological patterns in RSV-infected children with acute respiratory failure (ARF) in the peri-intubation period are associated with prolonged duration of mechanicalventilation. Materials and methods We included RSV-infected children 8 days, a backward stepwise regression arrived at a model that included age and right and left lung atelectasis. Using day 2 chest radiograph results, the best model included age and left lung atelectasis. A model combining the two days’ findings yielded an area under the ROC curve of 0.92 with a satisfactory fit (P=0.95). ConclusionChest radiological patterns around the time of intubation can identify children with RSV-associated ARF who would require prolonged mechanical ventilation. Keywords RSV infection . Pediatric ICU . Mechanical ventilation . Chest radiograph . Outcome
Introduction Infection caused by respiratory syncytial virus (RSV) is a leading cause of hospitalization in the US for infants younger than 1 year. It has been estimated that more than 120,000 infants in the US are hospitalized annually with RSV infection [2, 3]. RSV infection in infants causes significant morbidity, as 7–21% of these hospitalized infants require mechanical ventilation [4, 5]. Several studies in RSV-infected children have investigated risk factors associated with a more severe clinical course [5–18]. Younger age atpresentation, lower weight on admission, prematurity, early ventilatory parameters, associated congenital heart disease, chronic lung disease, immunodeficiency, specific neuroendocrine profile, specific polymorphisms, and elevated liver transaminases have all
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been associated with longer duration of mechanical ventilation in RSV-infected children [5–32]. Afew studies have investigated chest radiological patterns in both ventilated and nonventilated patients with bronchiolitis [17, 19–26, 33, 34]. We have retrospectively investigated whether specific chest radiological patterns in RSV-infected children with acute respiratory failure – immediately prior to endotracheal intubation and during the first 2 days after endotracheal intubation – areassociated with a prolonged duration of mechanical ventilation .
end expiratory pressure, attempting to prevent further loss of lung volume. Other means of mechanical ventilation, such as high-frequency oscillatory ventilation, were not used during the years included in our study. All children received adequate analgesia and sedation. Neuromuscular blockades were occasionally used when thoughtindicated by the attending physician. Bronchodilators were used only when it was thought that patients had a therapeutic response after an initial dose. Hydration and electrolytes were closely monitored to maintain normal levels. Children were assessed daily for their ability to wean ventilatory parameters. Radiological evaluation
Materials and methods The Institutional Review Board for humansubjects of the Massachusetts General Hospital approved the study. We conducted a retrospective medical record review of children aged 1 year and younger admitted with RSV infection and acute respiratory failure to the pediatric critical care unit at Massachusetts General Hospital, a tertiary care medical center, during the years 1996 through 2002. Children with RSV infection were identified from the...