Burden of respiratory support differs between critically ill children with severe bacterial and viral pneumonia

Sin Wee Loh, Judith Ju-Ming Wong, Oon Hoe Teoh, Jia Wen Janine Cynthia Koh, Yee Hui Mok, Jan Hau Lee

Abstract

Background: We hypothesized that children with viral pneumonia have higher severity of illness and higher mechanical ventilation (MV) requirement than children with bacterial pneumonia. We aim to compare respiratory support requirements of severe viral and bacterial pneumonia cases admitted to the pediatric intensive care unit (PICU).
Methods: This is a retrospective review of patients with microbiologically proven severe viral and bacterial pneumonia admitted to PICU in KK Women’s and Children’s Hospital, Singapore, from 2010 to 2014. Demographic, clinical and ventilatory data up to 14 days of PICU admission were extracted and analyzed.
Results: Forty-nine and 68 patients had sole viral and bacterial pathogens, respectively. Patients with viral pneumonia were more likely to be <2 years old (51.0% vs. 27.9%, P=0.011), to have underlying comorbidities (59.2% vs. 35.3%, P=0.010) and had higher pediatric index of mortality 2 (PIM2) score [3.0 (1.1, 8.0) vs. 1.6 (0.8, 3.0), P<0.001]. Patients with viral pneumonia were more likely to require alternative modes of MV (48.5% vs. 24.5%, P=0.008) and required longer duration of MV [7.0 (4.0, 10.0) vs. 4.0 (1.0, 10.8) days, P=0.031]. Oxygenation index (OI) of children with viral pneumonia was higher on day 1 [OI: 11.7 (6.6, 19.3) vs. 5.7 (3.7, 10.8), P=0.006] and 3 [OI: 8.0 (6.0, 20.0) vs. 5.0 (3.0, 8.0), P<0.001] of PICU admission. Acute respiratory distress syndrome (ARDS) was more common in children with viral pneumonia (22.4% vs. 0%, P<0.001).
Conclusions: Children with viral pneumonia were more likely to require alternative modes of MV and longer duration of MV.