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Management of severe bronchiolitis: indications for ventilator support.

AIM
Bronchiolitis is a common respiratory illness in children. We reviewed our experience of children under one year presenting to an intensive care unit with a clinical diagnosis of bronchiolitis in order to determine if ethnicity, prematurity, arterial carbon dioxide tension or nasopharyngeal aspirates positive for respiratory syncytial virus were related to the need for ventilator assistance.


METHOD
A review of the charts of all infants with bronchiolitis admitted to the paediatric intensive care unit from December 1991 to February 1994 was undertaken.


RESULTS
There were 94 infants. Ventilator assistance was given to 24 children--nine children had nasopharyngeal continuous positive airway pressure and 15 children required intermittent positive pressure ventilation. There was no difference in ethnic mix between the respiratory support group (Maori 45%, Pacific Islands 30%, other 25%) and those children managed conservatively (Maori 40%, Pacific Islands 36%, other 24%). Fifteen of the 24 infants who needed ventilator support were born prematurely. The mean (corrected) age of infants who required respiratory support was 1.79 (SD2.98) months compared to 3.32 (SD2.58) months for those infants who did not (p < 0.01). We were able to match 19 of the 24 infants who required ventilator support by age, sex and ethnicity with a nonventilated child. There was no significant difference in admission PaCO2 between groups (7.7 SD 1.5 vs 8.1 SD 1.5 kPa) or highest PaCO2 in the first 24 hours for nonventilated children and preintubation PaCO2 in ventilated children (8.6 SD1.3 vs 8.9 SD 1.9kPa). Nasopharyngeal aspirates were positive for respiratory syncytial virus in 39 patients. Respiratory support was required for 13 children who had positive RSV aspirates and for nine children who were not RSV positive (NS).


CONCLUSION
Infants with bronchiolitis that were premature were not likely to need respiratory support. Ethnicity, arterial PaCO2 and positivity for RSV were not related to the need for ventilator assistance.