ObjectiveTo 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.MethodsLongitudinal 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.ResultsSixty-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.ConclusionThe 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.
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