The Need for Inotropic Support in a Subgroup of Infants with Severe Life-Threatening Respiratory Syncytial Viral Infection

Abstract

Background

We experienced an unusual complication of life-threatening respiratory syncytial viral disease cardiovascular compromise. Life-threatening respiratory syncytial virus (RSV) infection has predominancy involved with ventilatory support for respiratory distress and/or failure. We performed a retrospective chart review of 20 consecutive infants admitted to the pediatric intensive care unit (PICU) for impending respiratory failure.

Methods

Seventeen required ventilatory support. As part of the infants' initial assessment, blood pressure, distal perfusion [capillary refill time (CRT) ≥ 3 sec], decreased peripheral pulses, and peripheral mottling were used to determine cardiovascular compromise. These infants received volume resuscitation either at the referring facility or the PICU until euvolemia was obtained, as determined by central venous pressure (CVP) monitoring (between 3 to 7 cm H₂O). Nine of the 20 infants did not respond to volume resuscitation alone and required vasopressor support in the form of: Dopamine (7 patients, 5-10 µg/kg/min), Dobutamine (2 patients, 5-7 µg/kg/min), and one who expired required both Epinephrine (600 ng/kg/min) and Dopamine (10 µg/kg/min). The mean ages of these 9 patients were 6.2 ± 3.4 weeks (range 3-12 weeks), the mean duration of ventilation was 7.2 ± 4.1 days (range 4-12 days). The mean duration of pharmacologic support was 69.7 ± 47 hours (range 14-168 hours). The mean ages of RSV+ infants not requiring inotropic support was 19.4 ± 27.4 weeks (range 1-90 weeks), and mean duration of ventilation was 5.5 ± 5.9 days (range 2-20 days).

Results

The inotrope treated patients were weaned from pharmacologic support prior to extubation, without any hemodynamic deficits. Our experience with this rather high incidence of hemodynamic complications during this RSV epidemic was unexpected.

Conclusions

These results substantiate the fact that younger patients with RSV disease are at both greater risk for pulmonary complications and cardiovascular deterioration and may thus benefit from pharmacologic support.