Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome
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ORIGINAL ARTICLE
Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome Marwa M. H. Ghazaly 1,2 & Nagla H. Abu Faddan 1 & Duaa M. Raafat 1 & Nagwa A. Mohammed 1 & Simon Nadel 1,2 Received: 21 July 2020 / Revised: 19 October 2020 / Accepted: 21 October 2020 # The Author(s) 2020
Abstract The Pediatric Acute Lung Injury Consensus Conference (PALICC) published pediatric-specific guidelines for the definition, management, and research in pediatric acute respiratory distress syndrome (PARDS). Acute viral bronchiolitis (AVB) remains one of the leading causes of admission to PICU. Respiratory syncytial virus (RSV) is the most common cause of AVB. We aimed to evaluate the incidence of PARDS in AVB and identify the risk of RSV as a trigger pathogen for PARDS. This study is a retrospective single-center observational cohort study including children < 2 years of age admitted to the pediatric intensive care unit at St Mary’s Hospital, London, and presented with AVB in 3 years (2016–2018). Clinical and demographic data was collected; PALICC criteria were applied to define PARDS. Data was expressed as median (IQR range); non-parametric tests were used. In this study, 144 infants with acute viral bronchiolitis were admitted to PICU in the study period. Thirty-nine infants fulfilled criteria of PARDS with RSV as the most common virus identified. Bacterial infection was identified as a risk factor for development of PARDS in infants with AVB. Conclusion: AVB is an important cause of PARDS in infants. RSV is associated with a higher risk of PARDS in AVB. Bacterial co-infection is a significant risk factor for development of PARDS in AVB. Keywords Bronchiolitis . Children . ARDS . Intensive care . Respiratory syncytial virus . RSV
What is Known: • Bronchiolitis is a common cause of respiratory failure in children under 2 years. • ARDS is a common cause of PICU admission. What is New: • Evaluation of bronchiolitis as a cause of PARDS according to the PALLIC criteria. • Evaluation of different viruses’ outcome in PARDS especially RSV as a commonest cause of AVB.
Communicated by Daniele De Luca Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s00431-02003852-9. * Simon Nadel [email protected]
Nagwa A. Mohammed [email protected]
Marwa M. H. Ghazaly [email protected]
1
Department of Pediatrics, Children University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
Nagla H. Abu Faddan [email protected]
2
Paediatric Intensive Care Unit, St Mary’s Hospital, Imperial College London Healthcare NHS Trust, London, UK
Duaa M. Raafat [email protected]
Eur J Pediatr
List of abbreviations AVB Acute viral bronchiolitis ETT Endotracheal tube HMPV Human metapneumovirus HFOV High frequency oscillating ventilation LRTI Lower respiratory tract infection LOS Length of stay MV Mechanical ventilation NPA Nasopharyngeal aspirate PALICC Pediatric Acute Lung Injury Consensus Conference PICU Pediatric intensive care uni
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