ARDS AS A RESULT OF A SEVERE RSV INFECTIO N - TREATMENT OPTIONS

We report on a strikingly frequent referral of former preterm babies w ith respiratory syncytial virus (RSV) infection and subsequent ARDS in our hospital during the winter 1994/95 with regard to the clinical co urse under application of alternative treatment modalities. Treatment modalities like inhalational ribavirin, use of bronchodilators and ins tillation of surfactant had been tried without success. All children ( age: 1-43 months) were ventilated for 6.6 (1-17) days with FiO(2) = 1. 0 and a mean airway pressure of 16.4 (10-24) cm H2O. Mean arterial blo od gases were 49 (paO(2)) and 41 (pCO(2)) mmHg, the OI was 33.4. By in halational NO in combination with IPPV or HFOV 4 patients could be sta bilized, in the other 6 ECMO became necessary. Two of them died in spi te of several weeks on ECMO; 8 children survived and could be discharg ed home after a mean hospital stay of 3 months. Even in very severe ca ses of RSV infection treatment modalities like NO, HFOV and ECMO can b e used successfully. The use of these treatment modalities must be con sidered before the lung damage is irreversible; in those cases a pre-e xisting BPD is no contraindication even for extracorporeal lung suppor t.