RISK FACTORS: Contact with infected person, Children in day care environment, Heart-lung transplantation patient, Adults - exposure to toxic fumes, connective tissue disease
GENERAL MEASURES:
β’ Most critical phase is fi rst 48-72 hours after onset. Treatment is usually symptomatic.
β’ Fluid at maintenance
β’ Mechanical ventilation in respiratory failure
β’ Isolation: contact; handwashing most important
β’ Antiviral agents for selected high-risk patients
β’ Cardio-respiratory monitoring
β’ Inhaled bronchodilators are commonly used, although efficacy has been hard to demonstrate in controlled
studies
β’ Steroids may not change course - except in patients with reactive airway disease
DRUG(S) OF CHOICE;
β’ Oxygen
β’ Albuterol: may be effective for acute symptoms
β’ Epinephrine aerosols may be of more benefit
β’ Ribavirin: For infants and children, an inhaled antiviral agent active against RSV, may be indicated in patients with underlying cardio-pulmonary disease, young age (< 6 weeks), or with severe RSV (elevated pCO2; require mechanical ventilation - use with caution via ventilator). Nebulize via small particle aerosol generator (SPAG). Use of ribavirin has decreased in recent years, secondary to lack of significant clinical effi cacy.
PATIENT MONITORING
. If patient is receiving home care, follow daily by telephone for 2-4 days
. For hospitalized patient, monitor as needed depending on severity of infection. Bronchiolitis can be associated with apnea.
PREVENTION/AVOIDANCE:
. Hand washing
. Contact isolation of infected babies
. Persons with colds should keep contacts with infants to a minimum
. Palivizumab (Synagis), a monoclonal product, administered monthly, November through March, 15 mg/kg IM.
Available in single use vials of 100mg and 50mg. Used for RSV prevention in high risk patients:
. 28-32 weeks gestation and less than 6 months old in November
. Less than 28 weeks gestation and less than 12 months old
. Moderately severe BPD and up to two years old
. Hemodynamically signifi cant congenital heart disease (until age 6 months)
. RSV immune globulin, a human blood product, can also be used in at-risk patients. Monthly infusions of
750 mg/kg, November through March, in a controlled setting. Avoid fl uid overload. Vial is 50 mg/mL; infuse at 1.5-6 mL/kg/hr; monitor oximeter and vital signs.
. Both of these medications are quite expensive.
POSSIBLE COMPLICATIONS:
. Bacterial superinfection
. Bronchiolitis obliterans
. Apnea
. Respiratory failure
. Death
. Increased incidence of RAD
EXPECTED COURSE/PROGNOSIS:
β’ In most cases, recovery is complete within 7-10 days
β’ Mortality statistics differ, but probably under 1%
β’ High-risk infants (BPD, CHD) may have prolonged course