Archives of Disease in Childhood, Vol 64, 1431-1437, Copyright © 1989 by Archives of Disease in Childhood.
Respiratory failure and mechanical ventilation in severe bronchiolitis
MH Lebel, M Gauthier, J Lacroix, E Rousseau and M Buithieu
Paediatric Intensive Care Unit, Hopital Sainte-Justine, University of Montreal, Canada.
A retrospective review of children who needed mechanical ventilation for
severe bronchiolitis identified 62 cases over a 10 year period. The mean
age at initiation of ventilation was 73 days (range: 14-201). Compared with
a group of 150 children in hospital for bronchiolitis but not transferred
to the intensive care unit, these 62 cases were significantly younger (73.0
compared with 166.3 days), and smaller (4.5 compared with 6.8 kg), and
significantly more had been born prematurely (40% compared with 16%). Taken
independently, age, weight, and prematurity were significantly associated
with the need for artificial ventilation, weight being the most important
factor. Using stepwise logistic regression, prematurity in itself added to
the quality of the prediction but age did not. The mean duration of
mechanical ventilation was 105 hours (range 2-381). Duration of ventilation
was significantly longer in children with a low gestational age at birth
and a positive familial history of atopy. There were no deaths, and no
patient developed pneumothorax or pneumomediastinum. Mechanical ventilation
is well tolerated and safe in acute bronchiolitis.
