• Caroline Davison, Kathleen M Ventre, Marco Luchetti, and Adrienne G Randolph.
• Department of Anaesthesia, St. George's Hospital, Tooting, London, UK.
• Pediatr Crit Care Me. 2004 Sep 1; 5 (5): 482-9.

BackgroundViral bronchiolitis is the leading cause of respiratory failure among infants in the United States. Currently, the mainstay of treatment is supportive care. The effectiveness of treatments used for mechanically ventilated infants with bronchiolitis is unclear.ObjectiveTo evaluate the strength of the evidence supporting the use of currently available treatments for critically ill infants with bronchiolitis.Data SourceWe searched PubMed, citations of relevant articles, personal files, and conference proceedings, and we contacted experts in the field.Study SelectionRandomized, controlled trials evaluating any therapy for bronchiolitis that included children in an intensive care unit.Data ExtractionTwo reviewers independently extracted data and assessed methodologic quality.Data SynthesisA total of 2,319 citations were screened, and 16 randomized, controlled trials were included. There were three trials of surfactant, three of ribavirin, three of immune globulin, three of systemic corticosteroids, and one each of vitamin A, interferon, erythropoietin, and heliox. A meta-analysis of the three surfactant studies showed a strong trend toward a decrease in duration of mechanical ventilation of 2.58 days (95% confidence interval, -5.34 to 0.18 days; p =.07) and a significant decrease of 3.3 intensive care unit days (95% confidence interval, -6.38 to -0.23 days; p =.04). A meta-analysis of the three systemic corticosteroid studies showed no overall effect on duration of mechanical ventilation when all three trials were combined (-0.62 day; 95% confidence interval, -2.78 to 1.53 days; p =.57). We identified one published meta-analysis of three ribavirin studies showing a significant decrease in ventilator days with ribavirin (-1.2 days; 95% confidence interval, -0.2 to -3.4 days; p =.2).ConclusionsCurrently, there are no clearly effective interventions available to improve the outcome of critically ill infants with bronchiolitis. Surfactant seems to be a promising intervention, and corticosteroids or ribavirin may also be beneficial.

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