Chest radiological patterns predict the duration of mechanical ventilation in children with RSV infection

RSV-infected children demonstrate various radiographic features, some of which are associated with worse clinical outcomes. To investigate whether specific chest radiological patterns in RSV-infected children with acute respiratory failure (ARF) in the peri-intubation period are associated with prolonged duration of mechanical ventilation. We included RSV-infected children < 1 year of age admitted with ARF from 1996 through 2002 to the pediatric intensive care unit at Massachusetts General Hospital. Their chest radiographs were evaluated at three time-points: preintubation (day -1) and days 1 and 2 after intubation. Univariate and multiple logistic regressions models were utilized to investigate our objective. The study included 46 children. Using day 1 chest radiograph findings to predict duration of mechanical ventilation of > 8 days, a backward stepwise regression arrived at a model that included age and right and left lung atelectasis. Using day 2 chest radiograph results, the best model included age and left lung atelectasis. A model combining the two days' findings yielded an area under the ROC curve of 0.92 with a satisfactory fit (P = 0.95). Chest radiological patterns around the time of intubation can identify children with RSV-associated ARF who would require prolonged mechanical ventilation.