Nasal continuous positive airway pressure decreases respiratory muscles overload in young infants with severe acute viral bronchiolitis.
OBJECTIVE
To determine the efficacy of nasal continuous positive airway pressure (nCPAP) on respiratory distress symptoms and respiratory effort in young infants with acute respiratory syncytial virus bronchiolitis.


METHODS
Prospective study.


METHODS
The paediatric intensive care unit of a university hospital.


METHODS
Twelve infants less than 3 months of age, with severe respiratory distress.


METHODS
Respiratory distress was quantified with a specific scoring system. Oesophageal pressure (Pes) was measured during spontaneous ventilation before and after nCPAP, delivered through an infant-adapted ventilator. Simultaneous recording of gastric pressure (Pgas) was performed in the five oldest patients.


RESULTS
The respiratory distress score decreased after nCPAP, particularly accessory muscles' use and expiratory wheezing. The breathing pattern was modified, with shorter inspiratory and longer expiratory time. Pes swings and PTPes(insp), two indices of inspiratory effort, were reduced by 54 (+/-4)% and 59 (+/-5)%. PTPgas(exp), an indicator of expiratory muscles activity, was completely abolished. A significant correlation was observed between the respiratory distress score and Pes swings at baseline and after nCPAP.


CONCLUSIONS
In young infants with severe acute respiratory syncytial virus bronchiolitis, nCPAP rapidly unloads respiratory muscles and improves respiratory distress symptoms.
Cambonie
Gilles
G
Pediatric Intensive Care Unit, CHU Montpellier, 34000 Montpellier, France. g-cambonie@chu-montpellier.fr
Milési
Christophe
C
Jaber
Samir
S
Amsallem
Francis
F
Barbotte
Eric
E
Picaud
Jean-Charles
JC
Matecki
Stefan
S
D001990:Bronchiolitis, Viral / Q000628:therapy*; D045422:Continuous Positive Airway Pressure; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D012119:Respiration; D012132:Respiratory Muscles / Q000502:physiology; D018357:Respiratory Syncytial Virus Infections / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome