Search

The modes of presentation and the management of acute respiratory failure in 11 infants with severe lower respiratory tract infections (due to respiratory syncytial virus in eight) are described. Progressive respiratory difficulties leading to exhaustion, peripheral circulatory collapse, recurrent apnoeic attacks, or generalized convulsions were the main clinical presentations resulting in severe ventilatory failure. In nine infants preventilation carbon dioxide tensions exceeded 65 mm Hg. It seems likely that the use of intermittent positive-pressure ventilation in these patients contributed to the low mortality rate, less than 0.5%, from such illnesses during the 15-month study period.

The action of a medicinal spray that contains anti-inflammatory and bacterio-static drugs integrated with the penetrating and potentiating agent DMSO has been evaluated clinically in 60 infants with acute respiratory obstruction. A dose of 2 ml of this spray is applied in the posterior pharynx and the tonsil region; 1 to 4 applications are made, according to the clinical evolution of the case. Two groups were chosen at random; 60 patients were paired off, and one of each pair received the treatment with DMSO spray. All the patients received ampicillin (50-100 mg/kg body weight). The following clinical results were observed. First there was an immediate recovery, after an average lapse of 30 min; improvement of sensorial involvement was observed in 80% of the cases, reduction of the intercostal retraction in 75%, reduction of polypnea in 76%, and transformation of the obstructive syndrome into a catarrhal syndrome in 80% (with fluidification of the secretions, which were expelled more easily by the upper air tracts). There was also a deferred or maintenance effect, which evaluated in comparsion with the control group that received similar treatment except for the nebulizations with DMSO spray. A sequential design, based on whether or not it was necessary to use the croupette, demonstrated the superiority of the DMSO spray over the control treatment in the bronchiolar process; in the group treated with DMSO spray it was not necessary to use the croupette. The sequential design based on the effect of this therapy on the general condition and the tabulated clinical factors permitted the inference that the therapeutic responses are more favorable in the group treated with DMSO spray than in the control group. In the sequential design, the line of significance is cut at the fifteenth pair (an error of 0.05 and P equals 0.95%). Since the application is easy, there are no toxic side effects and in view of the favorable results in the clinical evolution of the acute respiratory obstructive processes, we consider the use of this therapeutic spray very useful and beneficial in bronchiolitis.

Ten infants and children with respiratory failure, receiving standard maintenance water requirements, were treated on 13 occasions with intravenously given furosemide (1 to 2 mg/kg) because of continued impairment of oxygenation despite conventional therapy. Pulmonary auscultation and radiographs were normal or typical of the primary diagnosis. After a five-fold increase in urine output the mean Po2 rose from 61 mm Hg at a mean FiO2 of 0.7 to 140 mm Hg at an FiO2 of 0.65. The Pco2 decreased from 46 to 38 mm Hg. Interstitial pulmonary edema in these patients can be related to both their lung disease and impaired water tolerance during ventilatory therapy.

During an epidemic of respiratory syncytial (R.S.) virus in Newcastle upon Tyne 13 children developed R.S. virus infections while in hospital with other conditions. R.S. virus infection was also noted in four members of the staff. In two of the hospital wards outbreaks developed. All children infected with R.S. virus developed symptoms. The symptoms varied with age; two children aged 2 months or less developed colds, as did five children over 1 year of age. One child of 15 months with Werdnig-Hoffman disease, though suffering from a cold, later developed pulmonary collapse. All five children aged 3 to 8 months developed bronchiolitis. The effectiveness of special nursing in cubicles was probably diminished because adults with mild colds were excreting virus. The dangers of R.S. virus infection to other children in the ward, especially those with congenital heart disease, is emphasized.

Twenty-five cases of severe pneumonitis occurring among children aged 3 to 18 months were observed in Auckland, New Zealand, in 1965. An apparent relationship was established between a uniform disease picture and recovery of adenovirus type 21. Two died, and of the survivors 60% had permanent lung damage, probably resulting from obliterative bronchiolitis. Twenty per cent. were left with proved bronchiectasis. The possible relationships of adenovirus pneumonia to malnutrition or a genetic factor on the one hand and to the development of bronchiectasis on the other are discussed.