[Severe bronchiolitis. Epidemiology and clinical course of 284 patients].
BACKGROUND
Bronchiolitis is the leading cause of hospital admission and a frequent cause of pediatric intensive care unit (PICU) admission among infants during the winter months. The objective of this study was to analyze the characteristics and clinical course of patients admitted to the PICU for bronchiolitis.


METHODS
We performed a descriptive, observational study by clinical chart review of all patients admitted to the PICU for severe bronchiolitis from November 1994 to March 2006.


RESULTS
A total of 284 patients were included. Most were admitted during December and January and 74% had respiratory syncytial virus (RSV) infection. At least one risk factor for severe disease was present in 68% of the patients: the most frequent risk factor was age < 6 weeks (45%), followed by prematurity (30%). Mechanical ventilation was required in 64 of the 284 patients (24%). Mortality was 1.8% and was associated with chronic pre-existing illness (p < 0.001). The factors associated with a greater risk of mechanical ventilation and a longer PICU stay were the association of two or more risk factors (42/284; 15%), the presence of apnea (73/284; 25.7%), and images of pulmonary consolidation or atelectasis on admission chest X-ray (157/284; 55%).


CONCLUSIONS
Most patients admitted for severe bronchiolitis to the PICU are healthy infants whose principal risk factor is young age. The main predictors of severe clinical course during PICU stay are the association of two or more risk factors, the presence of apnea, and pulmonary consolidation on admission chest X-ray. Bronchiolitis-associated mortality is low and is associated with pre-existing chronic illness.
López Guinea
A
A
Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España. slguin@hotmail.com
Casado Flores
J
J
Martín Sobrino
María A
MA
Espínola Docio
B
B
de la Calle Cabrera
T
T
Serrano
A
A
García Teresa
María A
MA
D000367:Age Factors; D001049:Apnea / Q000453:epidemiology; D001990:Bronchiolitis, Viral / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D013902:Radiography, Thoracic; D012121:Respiration, Artificial; D018357:Respiratory Syncytial Virus Infections / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D012621:Seasons; D013997:Time Factors