MANAGEMENT OF SEVERE BRONCHIOLITIS - INDICATIONS FOR VENTILATOR SUPPORT

Aim. Bronchiolitis is a common respiratory illness in children. We rev iewed our experience of children under one year presenting to an inten sive care unit with a clinical diagnosis of bronchiolitis in order to determine if ethnicity, prematurity, arterial carbon dioxide tension o r nasopharyngeal aspirates positive for respiratory syncytial virus we re related to the need for ventilator assistance. Method. A review of the charts of all infants with bronchiolitis admitted to the paediatri c intensive care unit from December 1991 to February 1994 was undertak en. Results. There were 94 infants. Ventilator assistance was given to 24 children - nine children had nasopharyngeal continuous positive ai rway pressure and 15 children required intermittent positive pressure ventilation. There was no difference in ethnic mix between the respira tory support group (Maori 45%, Pacific Islands 30%, other 25%) and tho se children managed conservatively (Maori 40%, Pacific Islands 36%, ot her 24%). Fifteen of the 24 infants who needed ventilator support were born prematurely. The mean (corrected) age of infants who required re spiratory support was 1.79 (SD2.98) months compared to 3.32 (SD2.58) m onths 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 e thnicity with a nonventilated child, There was no significant differen ce 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 pr eintubation PaCO2 in ventilated children (8.6 SD1.3 vs 8.9 SD 1.9kPa). Nasopharyngeal aspirates were positive for respiratory syncytial viru s in 39 patients. Respiratory support was required for 13 children who had positive RSV aspirates and for nine children who were not RSV pos itive (NS). Conclusion. Infants with bronchiolitis that were premature were more likely to need respiratory support. Ethnicity, arterial PaC O2 and positivity for RSV were not related to the need for ventilator assistance.