Acute Respiratory Failure in Infants with Bronchiolitis

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Abstract
Bronchiolitis, an acute pulmonary infection of infants, results in acute respiratory failure and death in approximately 5% of hospitalized cases. Sequential arterial pH, PCO2 [CO2 pressure], and PO2 [[degree]2 pressure] levels, determined in 30 infants with bronchiolitis, revealed an uncompensated respiratory acidosis, hypoxemia in air, and a variable degree of yeno-arterial shunt. Measurement of physiologic deadspace-tidal volume ratios (VDp/Vx) and minute volumes in 5 infants showed that these infants had increased VDp/Vx ratios but could hold PaCO2 [arterial CO2 pressure] below 65 mm Hg by maintaining 2- - 3-fold increases in minute volume. As the infant became fatigued and minute volume fell to predicted basal levels, PacO2 rose to above 65 mm Hg, the level at which clinical signs of acute respiratory failure appeared. Nasotracheal intubation, neuromuscular blockade, and mechanical ventilation for an average period of 3 days prevented fatal asphyxia and restored normal ventilation in infants with extreme hypercapnea (mean PacO2 103 mmHg) and respiratory failure.

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