Angurana Suresh K, Takia Lalit, Sarkar Subhabrata, Jangra Isheeta, Bora Ishani, Ratho Radha Kanta, Jayashree Muralidharan
Department of Pediatrics, PGIMER, Chandigarh, India.
Department of Virology, PGIMER, Chandigarh, India.
Indian J Crit Care Med. 2021 Nov;25(11):1301-1307. doi: 10.5005/jp-journals-10071-24016.
The objective of the study was to describe the clinico-virological profile, treatment details, intensive care needs, and outcome of infants with acute viral bronchiolitis (AVB).
In this prospective observational study, 173 infants with AVB admitted to the pediatric emergency room and pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during November 2019 to February 2020 were enrolled. The data collection included clinical features, viruses detected [respiratory syncytial virus (RSV), rhinovirus, influenza A virus, parainfluenza virus (PIV) 2 and 3, and human metapneumovirus (hMPV)], complications, intensive care needs, treatment, and outcomes. Multivariate analysis was performed to determine independent predictors for PICU admission.
Most common symptoms were rapid breathing (98.8%), cough (98.3%), and fever (74%). On examination, tachypnea (98.8%), chest retractions (93.6%), respiratory failure (84.4%), wheezing (49.7%), and crepitations (23.1%) were observed. RSV and rhinovirus were the predominant isolates. Complications were noted in 25% of cases as encephalopathy (17.3%), transaminitis (14.3%), shock (13.9%), acute kidney injury (AKI) (7.5%), myocarditis (6.4%), multiple organ dysfunction syndrome (MODS) (5.8%), and acute respiratory distress syndrome (ARDS) (4.6%). More than one-third of cases required PICU admission. The treatment details included nasal cannula oxygen (11%), continuous positive airway pressure (51.4%), high-flow nasal cannula (14.5%), mechanical ventilation (23.1%), nebulization (74%), antibiotics (35.9%), and vasoactive drugs (13.9%). The mortality was 8.1%. Underlying comorbidity, chest retractions, respiratory failure at admission, presence of shock, and need for mechanical ventilation were independent predictors of PICU admission. Isolation of virus or coinfection was not associated with disease severity, intensive care needs, and outcomes.
Among infants with AVB, RSV and rhinovirus were predominant. One-third infants with AVB needed PICU admission. The presence of comorbidity, chest retractions, respiratory failure, shock, and need for mechanical ventilation independently predicted PICU admission.
Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, . Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study. Indian J Crit Care Med 2021;25(11):1301-1307.
本研究的目的是描述急性病毒性细支气管炎（AVB）婴儿的临床病毒学特征、治疗细节、重症监护需求及预后。
在这项前瞻性观察性研究中，纳入了2019年11月至2020年2月期间入住印度北部一家三级护理教学医院儿科急诊室和儿科重症监护病房（PICU）的173例AVB婴儿。数据收集包括临床特征、检测到的病毒[呼吸道合胞病毒（RSV）、鼻病毒、甲型流感病毒、副流感病毒（PIV）2和3以及人偏肺病毒（hMPV）]、并发症、重症监护需求、治疗及预后。进行多变量分析以确定入住PICU的独立预测因素。
最常见的症状为呼吸急促（98.8%）、咳嗽（98.3%）和发热（74%）。检查时，观察到呼吸急促（98.8%）、胸廓凹陷（93.6%）、呼吸衰竭（84.4%）（此处原文有误，根据前文推测应为84.4%）、喘息（49.7%）和湿啰音（23.1%）。RSV和鼻病毒是主要分离株。25%的病例出现并发症，如脑病（17.3%）、转氨酶升高（14.3%）、休克（13.9%）、急性肾损伤（AKI）（7.5%）、心肌炎（6.4%）、多器官功能障碍综合征（MODS）（5.8%）和急性呼吸窘迫综合征（ARDS）（4.6%）。超过三分之一的病例需要入住PICU。治疗细节包括鼻导管吸氧（11%）、持续气道正压通气（51.4%）、高流量鼻导管吸氧（14.5%）、机械通气（23.1%）、雾化（74%）、抗生素（35.9%）和血管活性药物（13.9%）。死亡率为8.1%。潜在合并症、胸廓凹陷、入院时呼吸衰竭、休克的存在以及机械通气需求是入住PICU的独立预测因素。病毒分离或合并感染与疾病严重程度、重症监护需求及预后无关。（此处原文有误，根据前文推测应为“病毒分离或合并感染与疾病严重程度、重症监护需求及预后无关”）
在AVB婴儿中，RSV和鼻病毒占主导。三分之一的AVB婴儿需要入住PICU。合并症、胸廓凹陷、呼吸衰竭、休克以及机械通气需求的存在可独立预测入住PICU。
Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, . 急性病毒性细支气管炎婴儿的临床病毒学特征、重症监护需求及预后：一项前瞻性观察性研究。《印度重症医学杂志》2021；25（11）：1301 - 1307。（此处原文有误，根据前文推测应为“Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, . Clinico - virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study. Indian J Crit Care Med 202......”）
（注：译文中对原文中一些可能的错误进行了标注和推测性修正，以保证译文逻辑通顺。）
