Critical Care

, 8:P214 | Cite as

Predictors of disease severity are similar for respiratory syncytial virus (RSV)-positive and RSV-negative induced respiratory failure

  • E Davis
  • K Deem
  • R Mehta
  • M Marsh
Poster presentation
  • 727 Downloads

Keywords

Respiratory Failure Congenital Heart Disease Congenital Heart Respiratory Syncytial Virus Predictive Factor 

Introduction

There are no reproducible parameters to predict the duration of ventilation and length of stay for RSV-induced respiratory failure in previously healthy children. Tasker [1] found an alveolar–arterial gradient (AaDO2) > 400 with mean airway pressure (MAP) > 10 in the first 24 hours, and an AaDO2 > 300 with MAP > 10 over the subsequent 24 hours identified RSV-positive cases at risk of a prolonged stay. Another study found an AaDO2 > 253 in the first 24 hours to be the best predictor of developing severe disease with the need for a prolonged stay.

Methods

Data were collected from 118 cases of respiratory failure in a regional pediatric ICU over four RSV seasons. Forty-six were excluded with an alternative diagnosis; of the remaining 72 cases of bronchiolitis, 52 were RSV-positive (six not ventilated), and 20 were RSV-negative. Of the 46 ventilated RSV-positive, three had congenital heart disease, four had chronic lung disease, and one had been treated in a different unit prior to admission. Of the 20 RSV-negative cases, three had congenital heart and/or chronic lung disease. Both groups were assessed against Tasker's criteria and a multiple regression model used to identify predictive markers with length of ventilation as the dependent variable.

Results

The median ages in the RSV-positive and RSV-negative groups were 0.13 (25th and 75th percentiles 0.05 and 0.23) and 0.11 (0.06 and 0.17), respectively. The length of ventilation was normally distributed with a mean (SD) of 110 (75) hours for the positive group and 110 (84) hours for the negative group. Mean (SD) lengths of stay of 7 (4) and 6 (4) days, respectively. The mean (SD) length of ventilation for those with AaDO2 > 400 within the first 24 hours was 127.7 (77.2) hours, AaDO2 > 300 for 24–48 hours was 127.2 (84.4) hours and AaDO2 > 253 in first24 hours was 122 (75.7) hours. Using Pearson's correlation the maximum MAP at 24 hours, 24–48 hours and the maximum ever were identified as potential predictive factors (P = 0.017, 0.037 and 0.038), for both the RSV-positive and RSV-negative groups. The maximum positive inspiratory pressure (PIP) at 24–48 hours may be predictive for RSV-positive (P = 0.079) and RSV-negative groups (P = 0.077). The multiple regression model found the maximum PIP between 24 and 48 hours in the combined group (RSV-positive and RSV-negative) to be an independent predictor of length of ventilation (P = 0.032), confirming the findings.

Conclusion

We have shown that the factors predicting severity of RSV-positive and RSV-negative respiratory failure are similar. We were unable to confirm the findings of previous studies suggesting that these are institute specific. In our institute a high MAP within the first 48 hours provides a predictive factor that can guide the clinician when talking to the parents and may help resource planning. A multicentre study in the UK is unlikely to yield more useful information.

References

  1. 1.
    Tasker RC, Gordon I, Kiff K: Acta Paediatr 2000, 89: 938-941. 10.1080/080352500750043387CrossRefPubMedGoogle Scholar

Copyright information

© BioMed Central Ltd. 2004

Authors and Affiliations

  • E Davis
    • 1
  • K Deem
    • 1
  • R Mehta
    • 1
  • M Marsh
    • 1
  1. 1.PICUSouthampton General HospitalUK

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