ABSTRACT
Bronchiolitis obliterans in children is an infrequent clinical syndrome, characterized by chronic airflow obstruction associated to inflammatory changes and different degrees of fibrosis in the small airways. Etiologies are varied but the most frequent one is the association with viral infections, mainly adenovirus. There is no consensus regarding diagnostic criteria, but a spectrum of persistent symptoms together with a mosaic pattern, bronchiectasis and persistent atelectasis is considered useful. Pulmonary biopsy has been questioned because of its low yield, invasiveness and complications. No specific treatment is available, therefore its treatment is supportive. Probably the best strategy is the aggressive use of antibiotics, constant kinesic and nutritional support and early pulmonary rehabilitation. This clinical guide represents a multidisciplinary effort, based on current evidence, to provide practical tools for the diagnosis and care of children and adolescents affected by post-infectious bronchiolitis obliterans.
La bronquiolitis obliterante (BO) es un síndrome clínico poco frecuente en niños, caracterizado por la obstrucción crónica al flujo de aire asociado a cambios inflamatorios y distintos grados de fibrosis en la vía aérea pequeña. Si bien existen muchas etiologías, la causa más frecuente se asocia a infecciones respiratorias virales, principalmente adenovirus. No existe un consenso para establecer su diagnóstico; sin embargo, se considera un espectro de síntomas persistentes asociados a un patrón en mosaico, bronquiectasias y atelectasias persistentes. El papel de la biopsia pulmonar ha sido cuestionado por su bajo rendimiento, invasividad y complicaciones. No existe un tratamiento específico por lo que el manejo es soporte. Probablemente la mejor estrategia constituya el empleo de antibióticos en forma agresiva, soporte kinésico y nutricional constante y una precoz rehabilitación pulmonar. Estas guías clínicas representan un esfuerzo multidisciplinario, basado en evidencias actuales para brindar herramientas prácticas para el diagnóstico y cuidado de niños y adolescentes con BO post infecciosa.
Subject(s)
Humans , Male , Adolescent , Female , Child, Preschool , Child , Bronchiolitis Obliterans/diagnosis , Bronchiolitis Obliterans/therapy , Respiratory Care Units/standards , Age Factors , Bronchiolitis Obliterans/physiopathology , Diagnosis, Differential , Hospitalization , Sex FactorsABSTRACT
OBJECTIVES: To review the characteristics and outcome of patients with childhood malignancy requiring respiratory intensive care treatment and to assess the outcome of these patients. DESIGN: Retrospective review of 22 oncological patients admitted to the pediatric respiratory intensive care unit between January 1, 1996 and December 31, 1998 (total 3 years.) RESULTS: The overall survival at discharge from the intensive care unit was 10 out of 22 (45%). The mean age of the patients was 4 years 5 months old (range 1 month to 14 years). Male:Female ratio was 1.2:1.21 patients had fever. All patients with a systemic or respiratory infective illness were neutropenic with a positive hemoculture in 17 out of 21 (81%) and 10 out of 20 (50%), respectively. The most common organisms detected were coagulase negative Staphylococcal aureus and Escherichia Coli. Sputum culture in the respiratory failure group was positive in 3 out of 7 patients, all of them grew Pseudomonas aeruginosa. Antibiotics were given to all oncological patients presenting with fever. The most common antibiotics administered were Ceftazidime, Amikacin and Imipenem. Fourteen patients needed mechanical ventilation. 11 of these 14 patients had respiratory tract infections, 1 patient had acute respiratory distress syndrome and the remainder were in a coma as a result of brain metastasis. Only 2 of them survived. The mean duration of stay in the respiratory intensive care unit was 10.9 days. CONCLUSIONS: There has been an improvement in the survival of oncology patients admitted to the intensive care unit especially for those with either a systemic or respiratory infection. Early and full intensive care treatment should be provided for these patients in order to improve the outcome.