Viral co-detection linked with longer duration of ventilation in critically ill infants

Identification of viral type and number may aid in predicting the duration of positive pressure ventilation in critically ill infants with bronchiolitis, according to results published in the Annals of the American Thoracic Society.

“In critically ill infants, these results provide some predictive value to aid in prognostication for parents, guide unit staffing and provide a benchmark for identification of infants whose severity of illness is outside of the norm,” Brittany L. Shutes, MD, pediatrician in the department of pediatrics in the division of pediatric critical care medicine at the Nationwide Children’s Hospital and the Ohio State University College of Medicine, and colleagues wrote.

Researchers conducted a 3-year retrospective cohort study that evaluated 984 infants in a quaternary pediatric ICU from February 2014 to February 2017. Patients received positive pressure ventilation (PPV) for presumed respiratory infection but without significant congenital heart disease, care limitations, baseline PPV usage or tracheostomy.

Researchers identified respiratory viruses and analyzed PPV duration according to viral etiology.

In the cohort, 64% of infants had a single virus detected, 23% of infants had two viruses, 4% had three viruses and 9% had no viruses. The most common viruses detected were respiratory syncytial virus (42%) and rhinovirus/enterovirus (15%).

Infants with more than two viruses detected had a longer duration of PPV compared with infants with one or no viruses (RR = 1.4; 95% CI, 1.2-1.6; P < .001). Detection of rhinovirus/enterovirus, compared with respiratory syncytial virus alone and other viral combinations, was associated with a shorter duration of PPV (RR = 0.7; 95% CI, 0.62-0.87; P < .001), noninvasive PPV (RR = 0.7; 95% CI, 0.6-0.85; P < .001) and invasive PPV (RR = 0.7; 95% CI, 0.54-0.83; P < .001) after adjusting for weight, prematurity and early antibiotic therapy administration, rhinovirus/enterovirus identification.

According to the researchers, the results of this study provide important insight and predictive value for critically ill infants despite the expense of systematic respiratory viral testing.

“Although systematic respiratory viral testing can be costly for critically ill infants, these results provide some important insight and predictive value. Importantly, ongoing improvements in this technology now make these results available to the bedside physician within a few hours,” the researchers wrote.

Looking ahead, Shutes and colleagues said these data “suggest that future randomized controlled studies of medications and other therapies in critically ill infants with respiratory infections should be stratified by viral type.”