Viral co-detection linked with longer duration of ventilatio
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Identification of viral type and number may aid in predicting the duration of positive pressure ventilation in critically ill infants with bronchiolitis, according to results published in the Annals of the American Thoracic Society.

Although respiratory virus testing is frequent done for critically ill infants with bronchiolitis, the prognostic value of this testing is unknown for those requiring positive pressure ventilation (PPV).

This study aimed to determine the differences in PPV utilization according to viral detection and to explore the association between viral detection and duration of PPV in critically ill children with presumed respiratory infection.

This was a retrospective cohort study in a quaternary pediatric intensive care unit. Researchers evaluated 984 children less than 1 year of age who received PPV for presumed respiratory infection without significant congenital heart disease, care limitations, baseline PPV usage, or tracheostomy. Respiratory viruses were identified using a PCR panel. Analyses of duration of PPV according to viral etiology were performed using univariate and multivariable logistic regression and truncated negative binomial regression with calculated mean marginal effect (MME).

-- Overall, 85 (9%) infants had no viruses identified, 629 (64%) had a single virus detected, most commonly respiratory syncytial virus (RSV) (417, 42%) followed by rhinovirus/enterovirus (RV/EV) (145, 15%), 230 (23%) had 2 viruses detected, and 40 (4%) had three viruses detected.

-- Compared to those with 1 or no virus detected, infants with more than 2 viruses received longer total PPV duration in adjusted analysis.

-- Detection of RV/EV alone, compared to RSV alone, was associated with significantly shorter duration of total PPV, noninvasive PPV, and invasive PPV when adjusted for weight, prematurity, and administration of early antibiotic therapy.

Conclusively, identification of viral type and number in severe bronchiolitis is an important predictor of duration of PPV.