Daily Dose: Impact of RSV Infection Among Patients with Respiratory Failure

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On April 20, 2023, we reported on a study published in the journal Frontiers in Medicine that investigated the 28-day mortality and clinical outcomes of respiratory syncytial virus (RSV) infection in patients with respiratory failure.

The study

This study was conducted in a tertiary care, university-affiliated teaching hospital in Thailand. Patients who were admitted to the medical ward and needed mechanical ventilation support for more than 24 hours due to respiratory failure between January 2014 and July 2019 were considered for the study. Patients aged ≥18 years who had respiratory samples analyzed were enrolled with RSV infection confirmation based on positive findings of respiratory pathogen testing.

Electronic health records were used to collect data on participant characteristics, clinical features, disease severity, hospital courses, and outcomes. Respiratory failure was determined as the respiratory system’s inability to meet requirements for oxygenation, ventilation, and metabolic demand. The primary outcome was 28-day mortality, with ventilator-dependent days, hospital length of stay (LOS), tracheostomy after respiratory failure, and hospital death being secondary outcomes.

There were 335 patients included in the final analysis, of which 67 were in the RSV group and 268 in the non-RSV group. No significant differences were found in the baseline characteristics of the 2 groups (mean age 72.7 and 71.0 years; men, 46.3% and 47.4%, respectively). The RSV group had a higher rate of community-acquired pneumonia and health care–associated pneumonia was more common in the non-RSV group.

The findings

Within the RSV group, there was a 38.8% 28-day mortality rate compared with 37.1% in the non-RSV group, and no significant differences were found in mortality rates, ventilator-dependent days, or LOS. Patients in the RSV group were more often given bronchodilator drugs (98.5% vs 60.8%) and ribavirin (80.6% vs 0.7%). Ventilator-associated pneumonia (52.2% vs 33.8%) and lung atelectasis (10.4% vs 3%) were more common in the patients in the RSV group compared with the non-RSV group.

Higher use of ribavirin and tracheostomy were seen in nonsurvivors vs survivors (95.8% vs 72.1%; 20.8% vs 4.7%). In-hospital death was associated with acute respiratory distress syndrome (relative risk [RR], 4.25; 95% CI, 1.58-11.42), ventilator-associated pneumonia (RR, 10.21; 95% CI, 4.83-21.59), and prolonged ventilator support (RR, 2.31; 95% CI, 1.03-5.21). RSV was not associated with increased hospital death.

Clinical implications

"This study indicated that RSV infection is associated with morbidity and mortality in patients with respiratory failure. To ensure prompt treatment if necessary, the patients should be monitored for the respiratory complications of VAP and lung atelectasis, particularly if prolonged mechanical ventilation support is provided. Moreover, this study implied that early weaning should be considered and that tracheostomy should be performed as soon as the need for prolonged airway or mechanical ventilator support is recognized."

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