Critical influenza A complicated with plastic bronchitis in children：15 cases report

Abstract:

Objective：To analyze the diagnosis and treatment characteristics of the critically illed children with influenza A virus in－fection complicated with plastic bronchitis（PB）. Methods：A retrospective investigation on the clinical manifestations，bronchoscope results，histological results of the aspirate，clinical course and outcome of 15 children with plastic bronchitis associated with influenza A virus infection in the Children’s Hospital of Chongqing from 2012 to 2013 was conducted. Results：All 15 patients were critically ill children with acute onset，rapid respiratory failure and underwent mechanical ventilation from the onset to the average（2.5±0.9） d；most cases involved the remaining lung rapidly（on the 2nd-3rd d of the course） from atelectasis of single lung or lung lobe. Leuko－cyte count，C-neactveprotein，procalcitonin and other inflammatory markers elevated. White jelly-like sputum was sucked out from all patients by using bronchoscopy，of which 11 cases was bronchial tree-like. All children suffered from severe hypercapnia and hypoxia；4 cases suffered from pneumothorax and one case from convulsions during the treatment. All children’s condition improved signif－icantly and with no death after sucking out the jelly-like sputum by bronchoscopy and ventilator treatment. Conclusion：PB is a life-threatening disease and children with critical influenza A virus infection are the susceptive population. In the epidemic season of in－fluenza A virus，plastic bronchitis should be considered in children undergoing rapid and progressive respiratory distress with lung at－electasis or consolidation on chest radiograph. If the patient poorly responds to conventional therapies，bronchoscopic extraction of casts should be carried out early. Meanwhile we should master the pointers and strategies of mechanical ventilation to reduce the oc－currence of the complications associated.