Aerosolized ribavirin in mechanically ventilated children with respiratory syncytial virus lower respiratory tract disease: A prospective, double- blind, randomized trial

Objective: To study the effect of ribavirin aerosol therapy on the immediate clinical course of mechanically ventilated children with respiratory syncytial virus lower respiratory tract disease. Design: Prospective, randomized, double-blind, placebo-controlled study. Setting: Pediatric intensive care unit (ICU) of a university teaching hospital. Patients: Forty-one children requiring mechanical ventilation for respiratory syncytial virus lower respiratory tract disease. Interventions: Patients were stratified by the presence or absence of and underlying disease and then randomized to receive aerosolized ribavirin (20 mg/mL) or saline for 18 hrs/day for 5 days or until endotracheal extubation, whichever came first. Measurements and Main Results: Dependent variables included the time course of the illness and the change in FIO₂, ventilatory rate, PaO₂/FIO₂ ratio, and ventilatory-efficiency index of patients while they received aerosol therapy. Ribavirin- and placebo-treated patient groups were not significantly different in the number of ventilator days (6.4 ± 6.9 vs. 8.2 ± 10.1; p = .5), oxygen days (10.8 ± 7.7 vs. 12.2 ± 11.8; p = .9), ICU days (7.9 ± 7.0 vs. 10.3 ± 11.0; p = .7), or hospital days (12.9 ± 9.7 vs. 16.2 ± 14.0; p = .6) after the initiation of aerosol therapy. The change in FIO₂, ventilatory rate, PaO₂/FIO₂ ratio, or ventilatory-efficiency index did not differ between the two groups. No ventilator malfunction was observed. There were six deaths caused by intractable hypoxemia in patients with underlying cardiopulmonary disease. Four of these deaths were in the placebo group and two in the ribavirin group (p = .5). Conclusions: Ribavirin aerosol therapy can be safely administered to mechanically ventilated children with severe respiratory syncytial virus lower respiratory tract disease. However, this therapy does not appear to affect immediate clinical outcome in such patients.