Destret respiratori tipus adult secundari a bronquiolitis per VRS

Objectives. Bronchiolitis is an uncommon cause of adult respiratory distress syndrome (ARDS). We report the cases of two twin infants that developed ARDS secondary bronchiolitis caused by respiratory syncytial virus (RSV). Case reports. Two 45 days-old twin sisters were admitted to the PICU with ARDS 48 hours after the diagnosis of bronchiolitis. The infants were born at 28 weeks of gestation, and had developed neonatal respiratory distress syndrome, for which they had required mechanical ventilation and surfactant therapy. Patient 1 was diagnosed with RSV bronchiolitis with right upper lobe atelectasis, and required conventional and high-frequency mechanical ventilation. Her clinical course was complicated by bilateral air-leak syndrome that required drainage. An ultrasound of the brain revealed periventricular hyperechogenicity that progressed to multicystic encephalomalacia. The patient developed refractory hypoxemia and died 27 days after admission. Patient 2 was also diagnosed with RSV bronchiolitis with right upper lobe atelectasis. She required high-frequency ventilatory support and the administration of nitric oxide. Her clinical course was complicated by renal failure, and she required peritoneal dialysis. Her respiratory status progressively improved, and the patient was extubated after 45 days of admission. With long-term follow up, no neurologic deficits were detected. Comments. High-frequency ventilation and nitric oxide administration are effective therapies for patients with ARDS secondary to RSV bronchiolitis. Extra-corporal membrane oxygenation would be indicated for cases of refractory hypoxemia in the absence of neurologic deficits. The administration of specific immunoglobulin against RSV could be used prophylactically in risk patients.