A technique for the administration of ribavirin to mechanically ventilated infants with severe respiratory syncytial virus infection.
Fifteen infants with respiratory syncytial virus pulmonary infection admitted to our pediatric ICU from December 1, 1985 through April 30, 1986, required mechanical ventilation. These patients were placed on an open trial of ribavirin therapy. We describe a technique for the safe delivery of aerosolized ribavirin to these infants while on the ventilator. The agent was delivered for 16 h/day for 7 days. Modifications of the ventilator circuit were needed to prevent the condensation of the drug in the ventilator tubing and to allow for the safe and effective operation of the ventilator. A common ventilator strategy was used for all patients. The highest positive inspiratory pressure generated was 42 +/- 9.5 (SD) cm H2O, the highest PEEP was 5.9 +/- 3.2 cm H2O, the duration of ventilation was 10.7 +/- 8.5 days, and exposure to fraction of inspired oxygen was greater than or equal to 0.6 for 55.3 h. Ribavirin levels were measurable in two patients, thereby demonstrating that the drug was in fact delivered and absorbed. Our preliminary results demonstrate that ribavirin can be delivered to the patients with respiratory syncytial viral infections who require mechanical ventilation; however, further studies are indicated to evaluate the efficacy and dose responsiveness, alterations in pulmonary dynamics, and safety of ribavirin in delivery to infants requiring ventilation.
Frankel
L R
LR
Department of Pediatrics, Stanford University Medical Center, CA 94305.
Wilson
C W
CW
Demers
R R
RR
Parker
J R
JR
Lewiston
N J
NJ
Stevenson
D K
DK
Smith
D W
DW
D000280:Administration, Inhalation; D000336:Aerosols; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009330:Nebulizers and Vaporizers; D012121:Respiration, Artificial; D012136:Respiratory Syncytial Viruses; D010253:Respirovirus Infections / Q000188:drug therapy / Q000628:therapy*; D012254:Ribavirin / Q000008:administration & dosage* / Q000627:therapeutic use; D012263:Ribonucleosides / Q000008:administration & dosage*
D000336:Aerosols; D012263:Ribonucleosides; D012254:Ribavirin