CPAP and HFOV: different guises of the same underlying intensive care strategy for supporting RSV bronchiolitis

Excerpt

Everyone on the planet is exposed to respiratory syncytial virus (RSV) infection by the age of 2 years. Most of the infants admitted to the paediatric intensive care unit (PICU) for respiratory support during this infection are previously healthy, but their principal risk for needing PICU treatment is young age (that is, if you are born in October/November in the northern hemisphere then your first winter exposure to RSV is likely to be when you are less than 4 months of age and vulnerable because of poor respiratory mechanical reserve [1]. However, if you are born in May/June, then you will be 7–8 months during your first winter exposure to RSV; much bigger, stronger and have more efficient thoracic and diaphragmatic mechanics.) In the PICU, the main predictors of severe outcome in previously well infants appear to be young age, presence of apnoea, and pulmonary consolidation on admission chest X-ray [2, 3]. Taken together, we can say that more severe RSV bronchiolitis in PICU practice is typically a problem of pulmonary consolidation and poor respiratory muscle reserve in the younger infant. …