Invasive monitoring in infants with respiratory syncytial virus infection

Objective: Coincident with a change in the physician staff in our pediatric intensive care unit (PICU), the frequency and duration of invasive monitoring were decreased. We examined the impact of this change on outcomes, complications, and hospital charges in infants admitted to the PICU with respiratory syncytial virus (RSV) infection. Study design: We reviewed medical records of all children less than 1 year of age who were admitted to the PICU from January 1989 to July 1993 with confirmed RSV infection, Patient characteristics, therapeutic interventions, outcomes, and hospital charges were extracted and compared. Results: Seventy-eight patients were identified, 38 admitted from January 1989 through July 1991 (group 1) and 40 from July 1991 through July 1993 (group 2), The groups were well matched in age, preexisting disease, and cardiorespiratory status on admission, Group 1 had significantly greater use of invasive monitoring, pharmacologic paralysis, inotropes, blood products, antibiotics, and parenteral nutrition, Outcomes were not different, but group 1 patients had significantly longer stays, more complications, and higher hospital charges. Conclusions: Routine use of invasive monitoring of PICU patients with RSV disease was associated with increased laboratory testing, overtreatment, and significant increases in costs and morbidity without improvement in outcome.