High-frequency oscillatory ventilation in RSV bronchiolitis patients

Abstract

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in infants and young children (1–3). Prematurity, bronchopulmonary dysplasia (BPD), congenital heart disease and immune disorders are wellknown risk factors associated with significant morbidity and mortality (4–7). These children may need prolonged hospitalization, mechanical ventilation and even extracorporeal membrane oxygenation (ECMO) when conventional mechanical ventilation (CMV) fails (8–11). RSV-induced respiratory failure is most often due to obstructive lung disease, although acute respiratory distress syndrome (ARDS) secondary to RSV infection has been described (3). High-frequency oscillatory ventilation (HFOV) may significantly improve oxygenation and outcome in pre-term infants with respiratory distress syndrome (12–16) and beyond the neonatal period in patients with a variety of diffuse alveolar diseases, such as ARDS and pneumonia (17–21). However, in small airway disease HFOV is considered potentially hazardous because of the risk of air trapping (17,22). Therefore, in clinical trials of HFOV, patients with small airway disease, including bronchiolitis, are generally excluded from study (18). We have found only one case report of HFOV to improve gas exchange and to avoid ECMO in a bronchiolitis patient (23). We report five patients with small airway disease caused by RSV bronchiolitis who were treated with HFOV as a rescue therapy after deterioration on CMV.