WB: RSV in Critically Ill Patients With Respiratory Failure Increases Complications

Respiratory syncytial virus increases the risk for respiratory complications in patients with respiratory failure, but not mortality.

RSV has received greater recognition as a serious disease that can progress to severe lower respiratory tract disease in immunocompromised adults and in those with other comorbidities. Between 10% and 30% of patients with RSV progress to acute respiratory failure that requires the use of a ventilator. The study of RSV in older adults is limited, as is the examination of RSV as a prognostic marker in patients with acute respiratory failure.

To address this, Surat Tongyoo, MD, and colleagues conducted a single-center, retrospective, matched cohort study in a tertiary-care university-affiliated teaching hospital in Bangkok, Thailand, and published the results in Frontiers in Medicine. “We investigated the clinical outcomes, treatments, and respiratory complications of patients with respiratory failure and RSV infection,” Dr. Tongyoo and colleagues explained. “To determine the influence of RSV infection on outcomes, we compared the outcomes of adult patients requiring respiratory support who had and did not have RSV infection during the same period.”

A total of 335 patients with respiratory failure were enrolled in the study, 67 of whom had a confirmed RSV diagnosis. No significant differentiating baseline characteristics were identified between the two groups (mean age, 72.7 ± 12.7 years vs 71 ± 14.8 years; male sex, 46.3% vs 47.4%; comorbidities, and initial Murray lung injury scores, 1.1 ± 0.8 vs 1.1 ± 0.9). The primary outcome of the study was 28-day mortality. The secondary outcomes were ventilator-dependent days, hospital length of stay, tracheostomy after respiratory failure, and hospital death.

Similar Mortality Rates, But More Clinical Complications

The primary outcome was similar between the two groups, with 38.8% (n=26) of the RSV group and 37.1% (n=9) of the non-RSV group having died within the 28-day period. The two groups also had similar hospital mortality rates, days spent on a ventilator, and hospital lengths of stay.

Certain treatment protocols were significantly different between the RSV and non-RSV groups; more patients in the RSV group received bronchodilators than those in the non-RSV group (98.5% vs 60.8%; P<0.001) and ribavirin (80.6% vs 0.7%; P<0.001). Other treatments including corticosteroids, renal replacement therapy, and tracheostomy were not shown to have any significant differences in administration between the RSV and non-RSV groups.

The RSV group had significantly more ventilator-associated pneumonia (VAP; 52.2% vs 33.8%; P=0.005) and lung atelectasis (10.4% vs 3%; P=0.009) than the non-RSV group. Complications such as acute respiratory distress syndrome (ARDS) and pleural effusion were similarly observed in both groups.

According to the findings of the study, RSV infection (relative risk [RR], 0.66; 95% CI, 0.31-1.42) was not associated with increased hospital death (Table). The multivariate analysis determined that the following factors did have a prognostic relationship with in-hospital death: ARDS (RR, 4.25; 95% CI, 1.58–11.42; P=0.004), VAP (RR, 10.21; 95% CI, 4.83-21.59; P<0.001), and prolonged ventilator support for more than 14 days (RR, 2.31; 95% CI, 1.03-5.21; P=0.04). Decreased mortality was observed with the use of tracheostomy (RR, 0.33; 95% CI, 0.13-0.82; P=0.02).

Practice Implications

“To ensure prompt treatment, if necessary, the patients [with RSV] should be monitored for the respiratory complications of VAP and lung atelectasis, particularly if prolonged mechanical ventilation support is provided,” Dr. Tongyoo and colleagues concluded. “Moreover, this study implied that early weaning should be considered, and that tracheostomy should be performed as soon as the need for prolonged airway or mechanical ventilator support is recognized.”