Infecciones respiratorias agudas en unidades de cuidados intensivos pediatricos. Estudio prospectivo multicentrico

Objective: The purpose of this study was to know the etiology, clinical background, treatment an evolution of severe infectious diseases in children admitted to Pediatric Intensive Care Units (PICUs). Patients and Methods: A multicenter prospective study was carried out. Children with respiratory infections admitted to 10 PICUs throughout Spain between May 1994 and April 1995 were included in a long term survey. The nosocomial infections were not included. Student's and Wilcoxon tests were used for quantitative variables and Chi square with Yates correction and Fisher's test for the qualitative variables. Results: One hundred twenty-two patients with acute respiratory infections were studied. Patients had a mean age of 2.1 ± 3 years (1 month- 14 years). The mean value of Downes' score at admittance was 5.2 ± 2.3. Diagnosis were allocated as follows: 47 bronchopneumonia (38.5%), 40 bronchiolitis (33%), 15 epiglotitis (12%), 14 laryngitis (11.5%) and 'others' 6 (5%). Etiologic agents were identified in 69 cases (56.5%), with respiratory syncytial virus being the most frequently isolated agent (35 cases, 51%), followed by Hemophilus influenzae in 13 cases (19%). The mean PICU stay was 5.8 ± 7.9 days (1 - 67 days). Of these cases, 112 (92%) recovered completely and 9 (7%) died (8 with bronchopneumonia and 1 with epiglotitis). A significant association could be seen between the increase in mortality and the variables Downes' score and diagnosis of bronchopneumonia. Conclusions: The most frequent respiratory infections in the PICU were pneumonia and bronchopneumonia. Viral etiology, with a frequency of 54%, was the main cause of respiratory infection. Bacterial etiology represented 46% of the total cases, with Hemophilus influenzae as the most frequent etiologic agent.