title: 6 cmH2O continuous positive airway pressure versus conventional oxygen therapy in severe viral bronchiolitis: a randomized trial.
abstract: OBJECTIVE
  To compare the effects of nasal continuous positive airway pressure (nCPAP) and conventional oxygen therapy on the clinical signs of respiratory distress and the respiratory muscle workload in acute viral bronchiolitis.
  
  
  METHODS
  Prospective, randomized, monocentric study carried out in the pediatric intensive care unit (PICU) of a university hospital.
  
  
  METHODS
  Infants <6 months old, admitted to the PICU with severe respiratory syncytial virus bronchiolitis.
  
  
  METHODS
  The patients were randomized into two groups for 6 hr. The nCPAP group (n = 10) received 6 cmH(2)O pressure support delivered by a jet flow generator and the control group (n = 9) received an air/oxygen mixture from a heated humidifier. Respiratory distress was assessed by the modified Wood's clinical asthma score (m-WCAS), and inspiratory muscle work was evaluated by calculating the pressure-time product per breath (PTP(insp) /breath) and per minute (PTP(insp) /min) from the esophageal pressure (Pes) recordings.
  
  
  RESULTS
  Compared with control condition, nCPAP decreased m-WCAS [-2.4 (1.05) vs. -0.5 (1.3), P = 0.03], PTPes(insp)/breath [-9.7 (5.7) vs. -1.4 (8.2), P = 0.04], PTPes(insp) /min [-666 (402) vs. -116 (352), P = 0.015], and FiO(2) [-7 (10) vs. +5 (15), P = 0.05]. Significant worsening of m-WCAS was only observed in the control group (4/9 vs. 0/10, P = 0.03).
  
  
  CONCLUSIONS
  nCPAP rapidly decreased inspiratory work in young infants with acute bronchiolitis. Improvement in the respiratory distress score at 6 hr was proportional to the initial clinical severity, suggesting the importance of rapid nCPAP initiation in the more severe forms of the disease.
authors.affiliation: Pediatric Intensive Care Unit, CHU Montpellier, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Milési
authors.forename: Stefan
authors.initials: S
authors.lastname: Matecki
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Thibaut
authors.initials: T
authors.lastname: Mura
authors.forename: Aurélien
authors.initials: A
authors.lastname: Jacquot
authors.forename: Odile
authors.initials: O
authors.lastname: Pidoux
authors.forename: Nathalie
authors.initials: N
authors.lastname: Chautemps
authors.forename: Aline Rideau Batista
authors.initials: AR
authors.lastname: Novais
authors.forename: Clémentine
authors.initials: C
authors.lastname: Combes
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Picaud
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
mesh_terms: D001990:Bronchiolitis, Viral / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D006801:Humans; D007223:Infant; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D012720:Severity of Illness Index