Characteristics and progression of children with acute viral bronchiolitis subjected to mechanical ventilation.
OBJECTIVE
To analyze the characteristics of children with acute viral bronchiolitis subjected to mechanical ventilation for three consecutive years and to correlate their progression with mechanical ventilation parameters and fluid balance.


METHODS
Longitudinal study of a series of infants (< one year old) subjected to mechanical ventilation for acute viral bronchitis from January 2012 to September 2014 in the pediatric intensive care unit. The children's clinical records were reviewed, and their anthropometric data, mechanical ventilation parameters, fluid balance, clinical progression, and major complications were recorded.


RESULTS
Sixty-six infants (3.0 ± 2.0 months old and with an average weight of 4.7 ± 1.4kg) were included, of whom 62% were boys; a virus was identified in 86%. The average duration of mechanical ventilation was 6.5 ± 2.9 days, and the average length of stay in the pediatric intensive care unit was 9.1 ± 3.5 days; the mortality rate was 1.5% (1/66). The peak inspiratory pressure remained at 30cmH2O during the first four days of mechanical ventilation and then decreased before extubation (25 cmH2O; p < 0.05). Pneumothorax occurred in 10% of the sample and extubation failure in 9%, which was due to upper airway obstruction in half of the cases. The cumulative fluid balance on mechanical ventilation day four was 402 ± 254mL, which corresponds to an increase of 9.0 ± 5.9% in body weight. Thirty-seven patients (56%) exhibited a weight gain of 10% or more, which was not significantly associated with the ventilation parameters on mechanical ventilation day four, extubation failure, duration of mechanical ventilation or length of stay in the pediatric intensive care unit.


CONCLUSIONS
The rate of mechanical ventilation for acute viral bronchiolitis remains constant, being associated with low mortality, few adverse effects, and positive cumulative fluid balance during the first days. Better fluid control might reduce the duration of mechanical ventilation.
Unidade de Terapia Intensiva Pediátrica, Hospital da Criança Santo Antônio, Porto Alegre, RS, Brazil.
Roberta
R
Ferlini
Unidade de Terapia Intensiva Pediátrica, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.
Flávia Ohlweiler
FO
Pinheiro
Unidade de Terapia Intensiva Pediátrica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil.
Cinara
C
Andreolio
Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Paulo Roberto Antonacci
PR
Carvalho
Departamento de Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Jefferson Pedro
JP
Piva
D060666:Airway Extubation; D001990:Bronchiolitis, Viral / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D012121:Respiration, Artificial; D015430:Weight Gain / Q000502:physiology