THE NEED FOR INOTROPIC SUPPORT IN A SUBGROUP OF INFANTS WITH SEVERE LIFE-THREATENING RESPIRATORY SYNCYTIAL VIRAL-INFECTION

Background: We experienced an unusual complication of life-threatening respiratory syncytial viral disease cardiovascular compromise, Life-t hreatening respiratory syncytial virus (RSV) infection has predominanc y involved with ventilatory support for respiratory distress and/or fa ilure, We performed a retrospective chart review of 20 consecutive inf ants admitted to the pediatric intensive care unit (PICU) for impendin g respiratory failure, Methods: Seventeen required ventilatory support , As part of the infants' initial assessment, blood pressure, distal p erfusion [capillary refill time (CRT) greater than or equal to 3 sec], decreased peripheral pulses, and peripheral mottling were used to det ermine cardiovascular compromise, These infants received volume resusc itation either at the referring facility or the PICU until euvolemia w as obtained, as determined by central venous pressure (CVP) monitoring (between 3 to 7 cm H2O), Nine of the 20 infants did not respond to vo lume resuscitation alone and required vasopressor support in the form of: Dopamine (7 patients, 5-10 mu g/kg/min), Dobutamine (2 patients, 5 -7 mu g/kg/min), and one who expired required both Epinephrine (600 ng /kg/min) and Dopamine (10 mu g/kg/min), The mean ages of these 9 patie nts were 6.2 +/- 3.4 weeks (range 3-12 weeks), the mean duration of ve ntilation was 7.2 +/- 4.1 days (range 4-12 days), The mean duration of pharmacologic support was 69.7 +/- 47 hours (range 14-168 hours), The mean ages of RSV + infants not requiring inotropic support was 19.4 /- 27.4 weeks (range 1-90 weeks), and mean duration of ventilation was 5.5 +/- 5.9 days (range 2-20 days), Results: The inotrope treated pat ients were weaned from pharmacologic support prior to extubation, with out any hemodynamic deficits, Our experience with this rather high inc idence of hemodynamic complications during this RSV epidemic was unexp ected, Conclusion: These results substantiate the fact that younger pa tients with RSV disease are at both greater risk for pulmonary complic ations and cardiovascular deterioration and may thus benefit from phar macologic support.