Original Article

Pediatric Radiology

, 39:117

First online:

Chest radiological patterns predict the duration of mechanical ventilation in children with RSV infection

  • Parthak ProdhanAffiliated withDivision of Pediatric Critical Care and Cardiology, College of Medicine, University of Arkansas for Medical Sciences
  • , Sjirk J. WestraAffiliated withDivision of Pediatric Radiology, Massachusetts General Hospital
  • , James LinAffiliated withDivision of Pediatric Critical Care, Mattel Children’s Hospital at UCLA
  • , Sarit Karni-SharoorAffiliated withPediatric Critical Care Unit, Shaarei Tzedek Medical Center
  • , Susan ReganAffiliated withDepartment of Medicine, Massachusetts General Hospital
  • , Natan NoviskiAffiliated withPediatric Critical Care Medicine, Massachusetts General Hospital Email author 

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Abstract

Background

RSV-infected children demonstrate various radiographic features, some of which are associated with worse clinical outcomes.

Objective

To investigate whether specific chest radiological patterns in RSV-infected children with acute respiratory failure (ARF) in the peri-intubation period are associated with prolonged duration of mechanical ventilation.

Materials and methods

We included RSV-infected children <1 year of age admitted with ARF from 1996 through 2002 to the pediatric intensive care unit at Massachusetts General Hospital. Their chest radiographs were evaluated at three time-points: preintubation (day −1) and days 1 and 2 after intubation. Univariate and multiple logistic regressions models were utilized to investigate our objective.

Results

The study included 46 children. Using day 1 chest radiograph findings to predict duration of mechanical ventilation of >8 days, a backward stepwise regression arrived at a model that included age and right and left lung atelectasis. Using day 2 chest radiograph results, the best model included age and left lung atelectasis. A model combining the two days’ findings yielded an area under the ROC curve of 0.92 with a satisfactory fit (P = 0.95).

Conclusion

Chest radiological patterns around the time of intubation can identify children with RSV-associated ARF who would require prolonged mechanical ventilation.

Keywords

RSV infection Pediatric ICU Mechanical ventilation Chest radiograph Outcome