López Guinea A, Casado Flores J, Martín Sobrino María A, Espínola Docio B, de la Calle Cabrera T, Serrano A, García Teresa María A
Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
An Pediatr (Barc). 2007 Aug;67(2):116-22. doi: 10.1016/s1695-4033(07)70571-4.
Bronchiolitis is the leading cause of hospital admission and a frequent cause of pediatric intensive care unit (PICU) admission among infants during the winter months. The objective of this study was to analyze the characteristics and clinical course of patients admitted to the PICU for bronchiolitis.
We performed a descriptive, observational study by clinical chart review of all patients admitted to the PICU for severe bronchiolitis from November 1994 to March 2006.
A total of 284 patients were included. Most were admitted during December and January and 74% had respiratory syncytial virus (RSV) infection. At least one risk factor for severe disease was present in 68% of the patients: the most frequent risk factor was age < 6 weeks (45%), followed by prematurity (30%). Mechanical ventilation was required in 64 of the 284 patients (24%). Mortality was 1.8% and was associated with chronic pre-existing illness (p < 0.001). The factors associated with a greater risk of mechanical ventilation and a longer PICU stay were the association of two or more risk factors (42/284; 15%), the presence of apnea (73/284; 25.7%), and images of pulmonary consolidation or atelectasis on admission chest X-ray (157/284; 55%).
Most patients admitted for severe bronchiolitis to the PICU are healthy infants whose principal risk factor is young age. The main predictors of severe clinical course during PICU stay are the association of two or more risk factors, the presence of apnea, and pulmonary consolidation on admission chest X-ray. Bronchiolitis-associated mortality is low and is associated with pre-existing chronic illness.
细支气管炎是冬季婴儿住院的主要原因，也是儿科重症监护病房（PICU）收治的常见原因。本研究的目的是分析因细支气管炎入住PICU的患者的特征和临床病程。
我们通过回顾1994年11月至2006年3月期间因严重细支气管炎入住PICU的所有患者的临床病历，进行了一项描述性观察研究。
共纳入284例患者。大多数患者在12月和1月入院，74%感染了呼吸道合胞病毒（RSV）。68%的患者存在至少一种严重疾病的危险因素：最常见的危险因素是年龄<6周（45%），其次是早产（30%）。284例患者中有64例（24%）需要机械通气。死亡率为1.8%，与慢性基础疾病相关（p<0.001）。与机械通气风险增加和PICU住院时间延长相关的因素包括两种或更多危险因素并存（42/284；15%）、存在呼吸暂停（73/284；25.7%）以及入院胸部X线检查显示肺部实变或肺不张（157/284；55%）。
因严重细支气管炎入住PICU的大多数患者是健康婴儿，其主要危险因素是年龄小。PICU住院期间严重临床病程的主要预测因素是两种或更多危险因素并存、存在呼吸暂停以及入院胸部X线检查显示肺部实变。细支气管炎相关死亡率较低，且与既往慢性疾病相关。
