title: Nasal continuous positive airway pressure decreases respiratory muscles overload in young infants with severe acute viral bronchiolitis.
abstract: 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.
authors.affiliation: Pediatric Intensive Care Unit, CHU Montpellier, 34000 Montpellier, France. g-cambonie@chu-montpellier.fr
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
authors.forename: Christophe
authors.initials: C
authors.lastname: Milési
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Francis
authors.initials: F
authors.lastname: Amsallem
authors.forename: Eric
authors.initials: E
authors.lastname: Barbotte
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Picaud
authors.forename: Stefan
authors.initials: S
authors.lastname: Matecki
mesh_terms: 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