ARDS infolge schwerer RSV-Infektion Therapeutische Optionen: Therapeutische Optionen

We report on a strikingly frequent referral of former preterm babies with respiratory syncytial virus (RSV) infection and subsequent ARDS in our hospital during the winter 1994/95 with regard to the clinical course under application of alternative treatment modalities. Treatment modalities like inhalational ribavirin, use of bronchodilators and instillation of surfactant had been tried without success. All children (age: 1–43 months) were ventilated for 6.6 (1–17) days with FiO(2) = 1.0 and a mean airway pressure of 16.4 (10–24) cm H(2)O. Mean arterial blood gases were 49 (paO(2)) and 41 (pCO(2)) mm Hg, the OI was 33.4. By inhalational NO in combination with IPPV or HFOV 4 patients could be stabilized, in the other 6 ECMO became necessary. Two of them died in spite of several weeks on ECMO; 8 children survived and could be discharged home after a mean hospital stay of 3 months. Even in very severe cases of RSV infection treatment modalities like NO, HFOV and ECMO can be used successfully. The use of these treatment modalities must be considered before the lung damage is irreversible; in those cases a pre-existing BPD is no contraindication even for extracorporeal lung support.