SEVERES FORMES OF ACUTE BRONCHIOLITIS IN INFANTS

The authors presented the result of a retrospective study of 167 infan ts suffering from severe forms of viral bronchiolitis, Population and methode : patient mean age was 74 +/- 72 days and their mean weight wa s 4,3 +/- 1,3 kg. A respiratory syncytial virus (RSV) was isolated fro m nasal aspiration of 139 patients. Neither corticoid nor bronchodilat ator nor anti-viral were used. Indications of mechanical ventilation, complications as well as predisposing facteurs were analysed. Results : thirty patients were oxygenated exclusively by Hood during 2 to 6 da ys (mean : 2,8 days) and 137 have benefited from a mechanical ventilat ion for 2 to 14 days (mean : 6,9 days). Main indications of mechanical ventilation were a prolonged or repeated apnea in 41 infants (30 %) a nd a rapid alteration of clinical status in 81 patients (59 %). Mean h ospitalization duration was 9,8 +/- 3,7 days, No death occurred. Upper lobe atelectasis (34 %), bacterial superinfection (9,6 %), hyponatrem ia (6,6 %), pneumothorax and/or pneumomediastinum (4,2 %) and seizures (4,2 %) were the major complications observed. The duration of mechan ical ventilation was not influenced by the age and the weight of patie nts on admission nor by bacterial superinfection but it was longer in case of ex-premature infants or atelectasis. Conclusion : careful nurs ing, close clinical supervision and a timely intervention of mechanica l ventilation are the essential measures in the management of the seve re forms of acute bronchiolitis.