The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

A CASE OF SEVERE RESPIRATORY SYNCYTIAL VIRUS PNEUMONIA REQUIRING MECHANICAL VENTILATION SUCCESSFULLY TREATED WITH INHALED RIBAVIRIN

Wen Xi Zhuang, Constance PL Lo, Herng Lee Tan; Singapore General Hospital, Singapore, Singapore

Introduction: Respiratory syncytial virus (RSV) is increasingly recognised as an adult pathogen and a cause of severe community acquired pneumonia (CAP) 1. Inhaled ribavirin is the only antiviral available in the treatment of RSV. Delivery of aerosolised ribavirin is especially challenging in patients receiving mechanical ventilation.We report a case of severe RSV pneumonia in an adult requiring mechanical ventilation successfully treated with aerosolised ribavirin delivered via a Puritan Bennett (PB) 7200 mechanical ventilator. Case Summary: A 53 year old Chinese male, with a 30 pack year smoking history and Ankylosing spondylitis with pulmonary restriction was admitted in July 2007 with acute hypercapneic respiratory failure requiring intubation and mechanical ventilation. He was treated initially as for severe pneumonia with intravenous antibiotics. Bronchoscopy with bronchoalveolar lavage confirmed RSV infection. After 2 failed attempts at extubation, a decision was made to deliver aerosolised ribavirin treatment (2g every 8 hours) via the Small Particle Aerosol Generator (SPAG), connected inline with PB7200 ventilator. After 3 days of treatment, the patient was successfully extubated. Outpatient review at 2 months showed resolution of his chest x-ray with his effort tolerance returning to his pre-hospitalisation level. Discussion: Aerosolised Ribavirin is the only antiviral treatment available for severe RSV. Delivering inhaled ribavirin through the ventilator circuit is technically challenging. The difficulties encountered included assembling an in-line water column relief valve that approximate the actual one (which we did not have), and fitting the different components of SPAG into the inspiratory limb of the ventilator. Initially, we experienced ventilator shut downs from the repeated opening of the high pressure safety relief valve. This problem resolved with a reduction of the external flow set on the blender. Accumulation of ribavirin crystals within the circuit mandated close monitoring of the airway pressures and frequent filter and circuit changes. Our experience demonstrates it is technically feasible to deliver aerosolised ribavirin through the ventilator circuit. This is made possible via close collaboration between respiratory therapists, nurses, physicians and biomedical engineers. Sponsored Research - None

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