INTRODUCTION
Acute viral bronchiolitis (AVB) affects mainly the bronchioles, causing mucosal inflammation, edema, and congestion in airways. Also, this inflammation reduces the airway caliber and obstructs the airflow, impairing breathing.1 AVB is one of the main acute respiratory diseases affecting infants and has clinical relevance due to the high morbidity. Moreover, the main causative agent of AVB is the respiratory syncytial virus (RSV), and its circulation increases, especially during autumn and winter. Infants born with less than 37 gestational weeks, low weight, heart or chronic lung disease (e.g., bronchopulmonary dysplasia), or immunodeficiency have a high risk of being severely infected with RSV, requiring hospitalization in pediatric intensive care units (PICU).2,3
RSV infection impairs lung function (especially on the fifth day), representing a major health challenge since its treatment depends on the severity and may progress to respiratory failure. Oxygen therapy is a supportive measure for mild cases, while noninvasive (NIV) and invasive mechanical ventilation (IMV) are used in moderate and severe cases involving acute respiratory failure (ARF). These measures are combined with salbutamol with hypertonic solution and bronchodilators, especially in patients with respiratory distress and requiring nasogastric tube feeding. However, the patient evolves to death if these measures are insufficient.1,4,5
About 75% of children with bronchiolitis hospitalized in PICU require ventilatory support, and 18% of these will need IMV because the disease severity may lead to respiratory distress. However, technological advances in PICU reduced the mortality related to severe bronchiolitis.6,7 In this sense, AVB is one of the main causes of hospitalization in PICU and may cause irreversible impairment of airways, resulting in reduced lung function that may remain the entire life.5,8
Intrinsic (e.g., comorbidities, disease severity at admission, and age) and extrinsic factors (e.g., health team experience, available resources, and clinical protocols) influences the prognosis of a child in severe condition in PICU.9 Thus, this study aimed to identify the epidemiological characteristics of children hospitalized with bronchiolitis in PICU at an emergency hospital.