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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2011 January;77(1):46-53
Right ventricular function in children with severe respiratory syncytial virus (RSV) bronchiolitis
Thorburn K. 1, Eisenhut M. 1, Shauq A. 2, Narayanswamy S. 2, Burgess M. 3 ✉
1 Department of Pediatric Intensive Care, Royal Liverpool Children’s Hospital - Alder Hey, Liverpool, UK;
2 Department of Pediatric Cardiology, Royal Liverpool Children’s Hospital - Alder Hey, Liverpool, UK;
3 Department of Cardiology, University Hospital Aintree, Liverpool, UK
BACKGROUND: Previous studies have demonstrated the development of myocardial damage and hepatitis in children with severe respiratory syncytial virus (RSV) infection. The aim of this study was to assess right ventricular function in children with severe RSV disease and to investigate an association with disease severity, myocardial damage, and hepatitis.
METHODS: This was a prospective observational study performed at a 20-bed regional multidisciplinary tertiary pediatric intensive care unit (PICU) in a university-affiliated children’s hospital. Pulse wave Doppler echocardiographic assessments with a calculation of the right ventricular function (Tei index), left ventricular ejection fraction and diameters, cardiac troponin T levels, transaminase and C-reactive protein levels were performed at admission on consecutive children who were ventilated and diagnosed with a severe RSV infection and without congenital heart disease.
RESULTS: Thirty-four ventilated children with confirmed RSV bronchiolitis were enrolled. The median age was 1.4 months (range 0.4-11.7), and the median length of ventilation was 5 days (range 2–10). Seven (20%) infants had an elevated right ventricular Tei index indicating reduced right ventricular function. Left ventricular function as well as C-reactive protein and transaminase levels were not different between patients with and without an elevated right ventricular Tei index. Cardiac troponin T was elevated in 14 patients (41%): 3/7 with an elevated and 11/27 with a normal Tei index (P=1). Ventilation and oxygenation indices and the duration of mechanical ventilation were not different between the two groups.
CONCLUSION: A raised right ventricular Tei index, consistent with reduced right ventricular function, was observed in severe RSV disease, but the degree of dysfunction was not related to the level of biochemical myocardial or hepatic damage or level of respiratory support.