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Vol. 45. Issue 8.
Pages 447-458 (November 2021)
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Vol. 45. Issue 8.
Pages 447-458 (November 2021)
Original
Viral etiology and outcome of severe lower respiratory tract infections among critically ill children admitted to the PICU
Etiología vírica y desenlace de infecciones de las vías respiratorias bajas entre niños críticamente enfermos ingresados en la UCIP
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M. Duyua,
Corresponding author
drmuhteremduyu@gmail.com

Corresponding author.
, Z. Karakayab
a Istanbul Medeniyet University, Goztepe Training and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey
b Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Pediatrics Istanbul, Turkey
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Figures (1)
Tables (4)
Table 1. Demographic, clinical and laboratory characteristics of children with critical LRTI.
Table 2. Frequency of respiratory viruses in LRTI.
Table 3. Comparison of demographic, clinical and laboratory characteristics with regard to specific respiratory viruses.
Table 4. Comparison of clinical outcome and effect of demographic, clinical and laboratory characteristics among children with viral LRTI.
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Abstract
Objective

To determine the viral etiology of severe lower respiratory tract infections (LRTIs), their clinical significance and prognosis among critically ill children.

Design

A prospective descriptive study was carried out.

Setting

Pediatric Intensive Care Unit (PICU) of Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.

Patients

A total of 115 patients hospitalized in the PICU were evaluated for inclusion in the study. Children with underlying comorbidities and those who did not require mechanical ventilation were excluded.

Main variables of interest

Demographic, clinical, laboratory test and radiographic data were recorded.

Results

A total of 63 patients were eligible for the study. The most common diagnosis was bronchiolitis (57.1%). Respiratory syncytial virus (RSV) was the most frequent causal virus (36.5%). The most common complication was acute respiratory distress syndrome (ARDS) (28.6%). Multiple viral infection was identified in 20.6% of the patients, the most common in this subgroup being rhinovirus. Patients with bocavirus infection had a higher likelihood of needing invasive mechanical ventilation (IMV) at presentation. Children who died were likely to be <12 months old, have ARDS, hepatitis, pneumomediastinum, multiple viral infection, and required IMV support with an increased duration of MV. Additionally, they were found to have a high Pediatric Risk of Mortality III score, Predicted Death Rate and increased need for inotropic support at admission.

Conclusions

Our study showed critically ill children with LRTI without known risk factors to have high mortality when aged <12 months, in the presence of multiple agents and when certain complications (ARDS, hepatitis) and X-ray findings were identified.

Keywords:
Acute lower respiratory tract infections
Children
Viral etiology
Mechanical ventilation
Pediatric intensive care unit
Resumen
Objetivo

Determinar la etiología vírica de las infecciones graves de las vías respiratorias bajas (IGVRB), su importancia clínica y su pronóstico en niños críticamente enfermos.

Diseño

Estudio descriptivo prospectivo.

Ámbito

Unidad de cuidados intensivos pediátricos (UCIP) del Hospital Universitario y de Investigación Goztepe, Universidad Medeniyet de Estambul, Turquía.

Pacientes y participantes

Se evaluó a un total de 115 pacientes ingresados en la UCIP para su posible inclusión en el estudio. Se excluyó a los niños con comorbilidades subyacentes y a aquellos que no requerían ventilación mecánica.

Variables de interés principales

Se registraron los datos demográficos, clínicos, de laboratorio y radiológicos de los pacientes.

Resultados

Un total de 63 pacientes fueron elegidos para participar en el estudio. El diagnóstico más habitual era bronquiolitis (57,1%). El virus sincitial respiratorio era el más común de los virus (36,5%). La complicación más habitual era el síndrome de dificultad respiratoria aguda (SDRA) (28,6%). Se identificaron múltiples infecciones víricas en el 20,6% de los pacientes, siendo la infección por el rinovirus la más común en este subgrupo. Los pacientes con infección por bocavirus presentaban una mayor probabilidad de necesitar ventilación mecánica invasiva (VMI) en el momento de la presentación. Los niños que murieron tenían una mayor probabilidad de presentar: edad <12 meses, SDRA, hepatitis, neumomediastino, infección multiviral y requerir MVI, con una mayor duración de la VM. Además, se observó que presentaban unos valores más altos de la escala PRISM III (Pediatric Risk of Mortality III) y tasa de mortalidad prevista, además de necesidad apoyo inotrópico en el momento del ingreso.

Conclusiones

Nuestro estudio demostró que los niños críticamente enfermos con LRTI sin factores de riesgo conocidos tienen una alta mortalidad cuando tienen menos de 12 meses, en presencia de múltiples agentes y cuando se identifican ciertas complicaciones (SDRA, hepatitis) y hallazgos de rayos X.

Palabras clave:
Infecciones agudas del tracto respiratorio inferior
Niños
Etiología viral
Ventilación mecánica
Unidad de cuidados intensivos pediátricos

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