Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome

Duaa M. Raafat,Marwa M. H. Ghazaly,Nagla H. Abu Faddan,Simon Nadel,Nagwa A. Mohammed

doi:10.1007/s00431-020-03852-9

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.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.

Highlights

Acute respiratory distress syndrome (ARDS) is an acute lung injury that can be triggered by a heterogeneous set of pulmonary and extrapulmonary etiologies
Our study aimed to evaluate the prevalence of pediatric acute respiratory distress syndrome (PARDS), based on the recent Pediatric Acute Lung Injury Consensus Conference (PALICC) definitions, in children with acute viral bronchiolitis (AVB) admitted to the pediatric intensive care units (PICUs)
Because the meaningfulness of logistic regression modeling we were restricted by the absolute number of PARDS cases, our model included four variables to evaluate the associations with the development of PARDS, choosing (RSV or not), age, Table 1 A comparison of demographics and clinical characteristics of all bronchiolitis infants with PARDS vs those without PARDS

Summary

Introduction

Acute respiratory distress syndrome (ARDS) is an acute lung injury that can be triggered by a heterogeneous set of pulmonary (direct lung injury) and extrapulmonary (indirect ling injury) etiologies. ARDS manifests as pulmonary inflammation, alveolar edema, and hypoxemic respiratory failure [1, 2]. ARDS in children (pediatric ARDS—PARDS) has been shown to have a lower mortality compared to adults [3, 4]. Infections account for more than half of the cases of PARDS, lower respiratory tract infections such as pneumonia and bronchiolitis, with viruses frequently implicated [3]. About 3.5 million children under 5 years of age are admitted annually to hospitals due to lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) worldwide [7]. RSV accounts for 22% of all acute LRTIs in children and is responsible for 66,000–199,000 deaths worldwide. Most childhood deaths due to RSV infection occur in developing countries [7]

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