Characteristics and treatment of severe adenovirus pneumonia in pediatric intensive care unit / 中国小儿急救医学

ABSTRACT

Objective To summarize the clinical features,treatment status and prognosis of severe community-acqnired pneumonia (CAP) caused by adenovirus in a single pediatric intensive care unit (PICU),and to explore the appropriate diagnosis and treatment strategies.Methods From August 2016 to January 2019,the clinical data of children with adenovirus pneumonia,including symptoms,organ function,laboratory features,rescue measures and results were analyzed retrospectively.Results A total of 531 cases with severe CAP were admitted in PICU,Shanghai Children's Hospital,Shanghai Jiaotong University.Among them,32 cases with adenovirus pneumonia accounted for 6.03％.The high incidence age was from 3 months to 2 years old (68.8％),and the average age was 18(12,37) months.High fever,respiratory distress and mental infirmity were the main symptoms.In acute stage,the pulmonary asymmetrical exudation lesion,partial exudation fusion and interstitial emphysema were observed by chest X rays.The main complications of extrapulmonary organ were cardiovascular disorder (63.1％),gastrointestinal disorder (50％),liver dysfunction (46.9％),coagulation dysfunction (31.3％) and nervous system dysfunction (26.1％).Respiratory support included high flow nasal oxygen therapy in 2 cases,mechanical ventilation in 30 cases,prone position ventilation in 12 cases,and continuous renal replacement therapy (CRRT) in 9 cases,extracorporeal membrane oxygenation (ECMO) therapy in 6 cases.There were 5 cases of death,and the hospital mortality was 15.6％.There were 4 cases survived by ECMO,and the discharge rate was 66.7％.Conclusion Adenovirus infection remains an important cause of CAP in PICU,and the mortality is high.Prone position ventilation,CRRT and ECMO may improve the survival rate of severe adenovirus pneumonia in children.