Pediatric Radiology

, 39:117

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

  • Parthak Prodhan
  • Sjirk J. Westra
  • James Lin
  • Sarit Karni-Sharoor
  • Susan Regan
  • Natan Noviski
Original Article



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


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.


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).


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


RSV infection Pediatric ICU Mechanical ventilation Chest radiograph Outcome 


  1. 1.
    Leader S, Kohlhase K (2003) Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000. J Pediatr 143:S127–S132PubMedGoogle Scholar
  2. 2.
    Shay DK, Holman RC, Newman RD et al (1999) Bronchiolitis-associated hospitalizations among US children, 1980–1996. JAMA 282:1440–1446PubMedCrossRefGoogle Scholar
  3. 3.
    Shay DK, Holman RC, Roosevelt GE et al (2001) Bronchiolitis associated mortality and estimates of respiratory syncytial virus associated deaths among US children, 1979–1997. J Infect Dis 183:16–22PubMedCrossRefGoogle Scholar
  4. 4.
    Frankel LR, Lewiston NJ, Smith DW et al (1986) Clinical observations on mechanical ventilation for respiratory failure in bronchiolitis. Pediatr Pulmonol 2:307–311PubMedCrossRefGoogle Scholar
  5. 5.
    Van Steensel-Moll HA, Van der Voort E, Bos AP et al (1989) Respiratory syncytial virus infections in children admitted to the intensive care unit. Pediatrie 44:583–588PubMedGoogle Scholar
  6. 6.
    Outwater KM, Crone RK (1984) Management of respiratory failure in infants with acute viral bronchiolitis. Am J Dis Child 138:1071–1075PubMedGoogle Scholar
  7. 7.
    Tissing WJ, van Steensel-Moll HA, Offringa M (1993) Risk factors for mechanical ventilation in respiratory syncytial virus infection. Eur J Pediatr 152:125–127PubMedCrossRefGoogle Scholar
  8. 8.
    Stretton M, Ajizian SJ, Mitchell I et al (1992) Intensive care course and outcomes of patients infected with respiratory syncytial virus. Pediatr Pulmonol 13:143–150PubMedCrossRefGoogle Scholar
  9. 9.
    Kneyber MC, Brandenburg AH, de Groot R et al (1998) Risk factors for respiratory syncytial virus associated apnoea. Eur J Pediatr 157:331–335PubMedCrossRefGoogle Scholar
  10. 10.
    Buckingham SC, Quasney MW, Bush AJ et al (2001) Respiratory syncytial virus infections in the pediatric intensive care unit: clinical characteristics and risk factors for adverse outcomes. Pediatr Crit Care Med 2:318–323PubMedCrossRefGoogle Scholar
  11. 11.
    Leclerc F, Scalfaro P, Noizet O et al (2001) Mechanical ventilatory support in infants with respiratory syncytial virus infection. Pediatr Crit Care Med 2:197–204PubMedCrossRefGoogle Scholar
  12. 12.
    Martinello RA, Chen MD, Weibel C et al (2002) Correlation between respiratory syncytial virus genotype and severity of illness. J Infect Dis 186:839–842PubMedCrossRefGoogle Scholar
  13. 13.
    Chan PW, Lok FY, Khatijah SB (2002) Risk factors for hypoxemia and respiratory failure in respiratory syncytial virus bronchiolitis. Southeast Asian J Trop Med Public Health 33:806–810PubMedGoogle Scholar
  14. 14.
    Prais D, Schonfeld T, Amir J; Israeli Respiratory Syncytial Virus Monitoring Group (2003) Admission to the intensive care unit for respiratory syncytial virus bronchiolitis: a national survey before palivizumab use. Pediatrics 112:548–552PubMedCrossRefGoogle Scholar
  15. 15.
    Eisenhut M, Thorburn K, Ahmed T (2004) Transaminase levels in ventilated children with respiratory syncytial virus bronchiolitis. Intensive Care Med 30:931–934PubMedCrossRefGoogle Scholar
  16. 16.
    Purcell K, Fergie J (2004) Driscoll Children’s Hospital respiratory syncytial virus database: risk factors, treatment and hospital course in 3,308 infants and young children, 1991 to 2002. Pediatr Infect Dis J 23:418–423PubMedCrossRefGoogle Scholar
  17. 17.
    Simpson W, Hacking PM, Court SD et al (1974) The radiological findings in respiratory syncytial virus infection in children. II. The correlation of radiological categories with clinical and virological findings. Pediatr Radiol 2:155–160PubMedCrossRefGoogle Scholar
  18. 18.
    Wilkesmann A, Ammann RA, Schildgen O et al; RSV Ped Study Group (2007) Hospitalized children with respiratory syncytial virus infection and neuromuscular impairment face an increased risk of a complicated course. Pediatr Infect Dis J 26:485–491PubMedCrossRefGoogle Scholar
  19. 19.
    Eriksson J, Nordshus T, Carlsen KH et al (1986) Radiological findings in children with respiratory syncytial virus infection: relationship to clinical and bacteriological findings. Pediatr Radiol 16:120–122PubMedCrossRefGoogle Scholar
  20. 20.
    Friis B, Eiken M, Hornsleth A et al (1990) Chest X-ray appearances in pneumonia and bronchiolitis. Correlation to virological diagnosis and secretory bacterial findings. Acta Paediatr Scand 79:219–225PubMedCrossRefGoogle Scholar
  21. 21.
    Newman B, Yunis E (1995) Lobar emphysema associated with respiratory syncytial virus pneumonia. Pediatr Radiol 25:646–648PubMedCrossRefGoogle Scholar
  22. 22.
    Kern S, Uhl M, Berner R et al (2001) Respiratory syncytial virus infection of the lower respiratory tract: radiological findings in 108 children. Eur Radiol 11:2581–2584PubMedCrossRefGoogle Scholar
  23. 23.
    Farah MM, Padgett LB, McLario DJ et al (2002) First-time wheezing in infants during respiratory syncytial virus season: chest radiograph findings. Pediatr Emerg Care 18:333–336PubMedCrossRefGoogle Scholar
  24. 24.
    Tasker RC, Gordon I, Kiff K (2000) Time course of severe respiratory syncytial virus infection in mechanically ventilated infants. Acta Paediatr 89:938–941PubMedCrossRefGoogle Scholar
  25. 25.
    Willson DF, Landrigan CP, Horn SD et al (2003) Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia. J Pediatr 143(5 Suppl):S142–S149PubMedGoogle Scholar
  26. 26.
    Lebel MH, Gauthier M, Lacroix J et al (1989) Respiratory failure and mechanical ventilation in severe bronchiolitis. Arch Dis Child 64:1431–1437PubMedCrossRefGoogle Scholar
  27. 27.
    Noviski N, Prodhan P, Westra SJ et al (2007) Chest radiological patterns and duration of mechanical ventilation in children with acute respiratory failure due to respiratory syncytial virus infection. Pediatr Crit Care Med 8:A41Google Scholar
  28. 28.
    Flamant C, Hallalel F, Nolent P et al (2005) Severe respiratory syncytial virus bronchiolitis in children: from short mechanical ventilation to extracorporeal membrane oxygenation. Eur J Pediatr 164:93–98PubMedCrossRefGoogle Scholar
  29. 29.
    Newth CJ (2000) Time course of severe respiratory syncytial virus infection in mechanically ventilated infants. Acta Paediatr 89:893–899PubMedCrossRefGoogle Scholar
  30. 30.
    Wang EE, Law BJ, Stephens D (1995) Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr 126:212–219PubMedCrossRefGoogle Scholar
  31. 31.
    Tasker R, Roe M, Bloxham D et al (2004) The neuroendocrine stress response and severity of acute respiratory syncytial virus bronchiolitis in infancy. Intensive Care Med 30:2257–2262PubMedCrossRefGoogle Scholar
  32. 32.
    Hoebee B, Rietveld E, Bont L et al (2003) Association of severe respiratory syncytial virus bronchiolitis with interleukin-4 and interleukin-4 receptor alpha polymorphisms. J Infect Dis 187:2–11PubMedCrossRefGoogle Scholar
  33. 33.
    Virkki R, Juven T, Rikalainen H et al (2002) Differentiation of bacterial and viral pneumonia in children. Thorax 57:438–441PubMedCrossRefGoogle Scholar
  34. 34.
    Korpi M (2004) Non-specific host response markers in the differentiation between pneumococcal and viral pneumonia: what is the most accurate combination? Pediatr Int 46:545–550CrossRefGoogle Scholar
  35. 35.
    Pare JP, Fraser RG (eds) (1983) Synopsis of diseases of the chest. Saunders, Philadelphia, PA, p 196Google Scholar
  36. 36.
    Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36PubMedGoogle Scholar
  37. 37.
    Roe M, O’Donnell DR, Tasker RC (2003) Respiratory viruses in the intensive care unit. Paediatr Respir Rev 4:166–171PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Parthak Prodhan
    • 1
  • Sjirk J. Westra
    • 2
  • James Lin
    • 3
  • Sarit Karni-Sharoor
    • 4
  • Susan Regan
    • 5
  • Natan Noviski
    • 6
  1. 1.Division of Pediatric Critical Care and Cardiology, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Division of Pediatric RadiologyMassachusetts General HospitalBostonUSA
  3. 3.Division of Pediatric Critical CareMattel Children’s Hospital at UCLALos AngelesUSA
  4. 4.Pediatric Critical Care UnitShaarei Tzedek Medical CenterJerusalemIsrael
  5. 5.Department of MedicineMassachusetts General HospitalBostonUSA
  6. 6.Pediatric Critical Care MedicineMassachusetts General HospitalBostonUSA

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