Respiratory Viruses in Mechanically Ventilated Patients

A Pilot Study

Raquel Nazareth; Maria-Jesus Chasqueira; Maria-Lúcia Rodrigues; Carolina Paulino; Catarina Conceição; Lia Lêdo; Úrsula Segura; Madalena Santos; António Messias; Pedro Póvoa; Paulo Paixão

Disclosures

BMC Pulm Med. 2020;20(39)

Conclusions

The results of this study suggest the presence of common respiratory viruses in the lower respiratory tract without determining symptomatic infection even in carefully collected lower samples. This may have important implications on the interpretation of the results on the diagnostic setting.

The accomplishment of a longitudinal study would allow to elucidate the length of stay of these viruses in the respiratory tract, and the existence or not of a permanent viral community in this environment.

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Abbreviations
APACHE II: Acute Physiology and Chronic Health Evaluation score; BAL: Bronchoalveolar lavage; Ct: Cycle Threshold; DNA: Deoxyribonucleic acid; HBoV: Human bocavirus; HCoV: Human coronavirus; HEV: Human enterovirus; HMPV: Human metapneumovirus; HPIV: Human parainfluenza virus; HRV: Human rhinovirus; ICU: Intensive Care Unit; PCR: Polymerase chain reaction; RNA: Ribonucleic acid; RSV: Respiratory syncytial virus; RTPCR: Reverse Transcription-Polymerase Chain Reaction; SAPS II: Simplified Acute Physiology Score; WORI-: Patients in study group with negative samples; WORI: Study group; WORI: Without respiratory infection; WORI+: Patients in study group with positive samples; WRI: Control group; WRI-: Patients in control group with negative samples; WRI: With respiratory infection; WRI+: Patients in control group with positive samples.

Acknowledgments
Not applicable.

Consent per publication
Not applicable.

Availability of data and material
The datasets used and/or analysed during the current study are available from the corresponding author on request.

Funding
The work was funded by the Infection unit of the NOVA Medical School, an academic unit of the NOVA University of Lisbon.

Ethics approval and consent to participate
The study was approved by the Ethics Committee of Beatriz Angelo Hospital (N/Ref. 1712/2016_MJHEB) and Ethics Committee of S. Francisco Xavier Hospital (CES, December 2019). All the patients, or their legal representatives, gave a written informed consent to participate in this study.

Table 1. Demographics, comorbidities and ICU clinical outcome of the study subjects: WORI group and WRI group
	Total (n = 44)	WORI group (n = 20)	WRI group (n = 24)
Age (years)	68.3 (20–87)	65.3 (20–87)	70.7 (42–87)
Male, n (%)	25 (56.8)	12 (60)	13 (54.2)
APACHE II	23.5 (3–49)	22.9 (13–37)	23.9 (3–49)
SAPS II	53.4 (12–103)	56.3 (22–103)	51 (12–93)
ICU length of stay (days)	9.7 (1–25)	9.9 (1–25)	9.6 (3–25)
ICU mortality, n (%)	17 (38.6)	10 (50)	7 (29.2)
Admission diagnosis, n
Respiratory	11	0	11
Cardiovascular	3	1	2
Shock	17	13	4
Cardio-respiratory arrest	5	1	4
Neurologic	7	4	3
Metabolic	1	1	0

APACHE II Acute Physiology and Chronic Health Evaluation score (0–71); SAPS II, Simplified Acute Physiology Score (0–163);
ICU intensive care unit, WRI with respiratory infection, WORI without respiratory infection

Table 2. Respiratory virus detected by RT-PCR in the two groups
	WORI group (n = 20)	WRI group (n = 24)
N° positive samples	6	12
> 1 virus	2	3
Influenza A(H3)	2	3
RSV	1	3
HRV	2	3
HMPV	1	3
HPIV 1/3	2	0
HEV	0	1
HBoV	0	2

Table 3. Patients characteristics in each subgroup of results (average values)
	WORI group (n = 20)		WRI group (n = 24)
	Virus positive (WORI+) (n = 6)	Virus negative (WORI-) (n = 14)	Virus positive (WRI+) (n = 12)	Virus negative (WRI-) (n = 12)
Age (years)	74.2	61.6	70.7	70.7
APACHE II	25.3	21.9	20.5	27.4
SAPS II	59.8	54.8	45	56.9
ICU length of stay (days)	4.8	12.1	9.1	10
Mechanical ventilation (days)	2.3	9.5	5.2	5.1
ICU mortality, n (%)	4 (66.7)	6 (42.9)	2 (16.7)	5 (41.7)

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A Pilot Study

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