Respiratory Virus Type, Number May Predict PPV Duration in Infants With Severe Bronchiolitis

Infant on mechanical ventilator in hospital
Infant on mechanical ventilator in hospital
The type and number of respiratory viruses in infants with severe bronchiolitis can predict the required duration of positive pressure ventilation use.

The type and number of respiratory viruses in infants with severe bronchiolitis can predict the required duration of positive pressure ventilation (PPV) use, study results in the Annals of the American Thoracic Society suggest.

This study was a retrospective analysis of electronic health record data of 984 infants younger than 1 year of age who were admitted to and discharged from a pediatric intensive care unit between 2014 and 2017. All infants had either a primary or secondary diagnosis of bronchiolitis, respiratory distress, or respiratory failure of varying degrees, as confirmed by International Classification of Diseases (ICD)-9/ICD-10 codes.

Infants had received PPV for presumed respiratory infection without care limitations, significant congenital heart disease, tracheostomy, or baseline PPV usage. Investigators identified respiratory viruses in the infants using a polymerase chain reaction (PCR) panel, and multivariable logistic regression was used to analyze the duration of PPV based on viral etiology.

No viruses were identified in 9% (n=85) of patients. Approximately 64% (n=629) of patients had a single virus, including respiratory syncytial virus (RSV; 42%) and rhinovirus/enterovirus (RV/EV; 15%). A total of 230 (23%) infants had 2 viruses, while 40 (4%) had 3 viruses.

In an analysis adjusted for weight, prematurity, and early antibiotic therapy, infants with at least 2 viruses had significantly longer total PPV duration compared with infants with 1 or no virus (relative risk [RR], 1.4; 95% CI, 1.2-1.6; P <.001). Additionally, RV/EV alone was associated with significantly shorter duration of total PPV (RR, 0.7; 95% CI, 0.62-0.87; P <.001), noninvasive PPV (RR, 0.7; 95% CI, 0.60-0.85; P <.001), and invasive PPV (RR, 0.7; 95% CI, 0.54-0.83; P <.001) compared with RSV alone.

The researchers also discovered an association between early antibiotic therapy with longer ventilation duration overall (RR, 1.92; 1.71-2.16; P <.001). In contrast, early antibiotic therapy was associated with shorter ventilation duration in patients who needed invasive mechanical ventilation (RR, 0.73; 95% CI, 0.54-0.98; P =.035).

Limitations of this study included its retrospective nature, single-center design, and the lack of a randomized protocol.

The investigators concluded that their findings offer “some predictive value to aid in prognostication for parents, guide unit staffing and provide a benchmark for identification of infants whose severity of illness is outside of the norm.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Shutes BL, Patel AB, Moore-Clingenpeel MD, Mejias A, Karsies TJ. Relationship of viral detection with duration of ventilation in critically ill infants with lower respiratory tract infection. Ann Am Thorac Soc. Published online March 4, 2021. doi:10.1513/AnnalsATS.202008-996OC