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01-10-2008 | Pediatric Original

Nasal continuous positive airway pressure decreases respiratory muscles overload in young infants with severe acute viral bronchiolitis

Authors: Gilles Cambonie, Christophe Milési, Samir Jaber, Francis Amsallem, Eric Barbotte, Jean-Charles Picaud, Stefan Matecki

Published in: Intensive Care Medicine | Issue 10/2008

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.

Design

Prospective study.

Setting

The paediatric intensive care unit of a university hospital.

Patients

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

Interventions

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.

Measurements and 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.

Welliver RC (2003) Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection. J Pediatr 143:S112–S117PubMedCrossRef

Boogaard R, Hulsmann AR, van Veen L, Vaessen-Verberne AA, Yap YN, Sprij AJ, Brinkhorst G, Sibbles B, Hendriks T, Feith SW, Lincke CR, Brandsma AE, Brand PL, Hop WC, de Hoog M, Merkus PJ (2007) Recombinant human deoxyribonuclease in infants with respiratory syncytial virus bronchiolitis. Chest 131:788–795PubMedCrossRef

Deshpande SA, Northern V (2003) The clinical and health economic burden of respiratory syncytial virus disease among children under 2 years of age in a defined geographical area. Arch Dis Child 88:1065–1069PubMedCrossRef

Brooks AM, McBride JT, McConnochie KM, Aviram M, Long C, Hall CB (1999) Predicting deterioration in previously healthy infants hospitalized with respiratory syncytial virus infection. Pediatrics 104:463–467PubMedCrossRef

Hammer J, Numa A, Newth CJ (1997) Acute respiratory distress syndrome caused by respiratory syncytial virus. Pediatr Pulmonol 23:176–183PubMedCrossRef

Stokes GM, Milner AD, Groggins RC (1981) Work of breathing, intra-thoracic pressure and clinical findings in a group of babies with bronchiolitis. Acta Paediatr Scand 7:689–694CrossRef

Keens TG, Bryan AC, Levison H, Ianuzzo CD (1978) Developmental pattern of muscle fiber types in human ventilatory muscles. J Appl Physiol 44:909–913PubMed

Essouri S, Nicot F, Clement A, Garabedian EN, Roger G, Lofaso F, Fauroux B (2005) Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure. Intensive Care Med 3:574–580CrossRef

Gherini S, Peters RM, Virgilio RW (1979) Mechanical work on the lungs and work of breathing with positive end-expiratory pressure and continuous positive airway pressure. Chest 76:251–256PubMedCrossRef

10.

Moa G, Nilsson K, Zetterstrom H, Jonsson LO (1988) A new device for administration of nasal continuous positive airway pressure in the newborn: an experimental study. Crit Care Med 16:1238–1242PubMedCrossRef

11.

Klausner JF, Lee AY, Hutchison AA (1996) Decreased imposed work with a new nasal continuous positive airway pressure device. Pediatr Pulmonol 22:188–194PubMedCrossRef

12.

Milesi C, Cambonie G, Barbotte E, Jacquot A, Jaber S, Picaud JC, Matecki S (2007) Effects of nasal continuous positive airway pressure (CPAP) on respiratory muscles work and respiratory distress symptoms in severe acute bronchiolitis. Pediatr Crit Care Med Suppl 8:A264CrossRef

13.

Cambonie G, Milesi C, Fournier-Favre S, Counil F, Jaber S, Picaud JC, Matecki S (2006) Clinical effects of heliox administration for acute bronchiolitis in young infants. Chest 129:676–682PubMedCrossRef

14.

Collett PW, Perry C, Engel LA (1985) Pressure-time product, flow, and oxygen cost of resistive breathing in humans. J Appl Physiol 58:1263–1272PubMedCrossRef

15.

Sassoon CS, Light RW, Lodia R, Sieck GC, Mahutte CK (1991) Pressure–time product during continuous positive airway pressure, pressure support ventilation, and T-piece during weaning from mechanical ventilation. Am Rev Respir Dis 143:469–475PubMed

16.

Hollman G, Shen G, Zeng L, Yngsdal-Krenz R, Perloff W, Zimmerman J, Strauss R (1998) Helium–oxygen improves Clinical Asthma Scores in children with acute bronchiolitis. Crit Care Med 26:1731–1736PubMedCrossRef

17.

Martinon-Torres F, Rodriguez-Nunez A, Martinon-Sanchez JM (2002) Heliox therapy in infants with acute bronchiolitis. Pediatrics 109:68–73PubMedCrossRef

18.

Pasterkamp H, Wiebicke W, Fenton R (1987) Subjective assessment vs computer analysis of wheezing in asthma. Chest 91:376–381PubMedCrossRef

19.

Elphick HE, Lancaster GA, Solis A, Majumdar A, Gupta R, Smyth RL (2004) Validity and reliability of acoustic analysis of respiratory sounds in infants. Arch Dis Child 89:1059–1063PubMedCrossRef

20.

Amsallem F, Ariole P, Voisin M, Jean R (1988) Bronchiolitis in infants. Respiratory functional exploration in the acute phase. Arch Fr Pediatr 45:329–336PubMed

21.

Argent AC, Newth CJ, Klein M (2007) The mechanics of breathing in children with acute severe croup. Intensive Care Med 34:324–332PubMedCrossRef

22.

Abbasi S, Duara S, Shaffer T, Fox WW (1984) Effect of external inspiratory loading on ventilation of premature infants. Pediatr Res 18:150–154PubMedCrossRef

23.

Pepe PE, Marini JJ (1982) Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: the auto-PEEP effect. Am Rev Respir Dis 126:166–170PubMed

24.

Brochard L (2002) Intrinsic (or auto-) PEEP during controlled mechanical ventilation. Intensive Care Med 28:1376–1378PubMedCrossRef

25.

Ninane V, Rypens F, Yernault JC, De Troyer A (1992) Abdominal muscle use during breathing in patients with chronic airflow obstruction. Am Rev Respir Dis 146:16–21PubMed

26.

MacIntyre NR, Cheng KC, McConnell R (1997) Applied PEEP during pressure support reduces the inspiratory threshold load of intrinsic PEEP. Chest 111:188–193PubMedCrossRef

27.

Graham AS, Chandrashekharaiah G, Citak A, Wetzel RC, Newth CJ (2007) Positive end-expiratory pressure and pressure support in peripheral airways obstruction: work of breathing in intubated children. Intensive Care Med 33:120–127PubMedCrossRef

28.

Thia LP, McKenzie SA, Blyth TP, Minasian CC, Kozlowska WJ, Carr SB (2008) Randomised controlled trial of nasal Continuous Positive Airways Pressure (CPAP) in bronchiolitis. Arch Dis Child 93:45–47PubMedCrossRef

29.

Locke RG, Wolfson MR, Shaffer TH, Rubenstein SD, Greenspan JS (1993) Inadvertent administration of positive end-distending pressure during nasal cannula flow. Pediatrics 91:135–138PubMed

30.

Sreenan C, Lemke RP, Hudson-Mason A, Osiovich H (2001) High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics 107:1081–1083PubMedCrossRef

31.

Courtney SE, Aghai ZH, Saslow JG, Pyon KH, Habib RH (2003) Changes in lung volume and work of breathing: a comparison of two variable-flow nasal continuous positive airway pressure devices in very low birth weight infants. Pediatr Pulmonol 36:248–252PubMedCrossRef

32.

Simma B, Fritz M, Fink C, Hammerer I (2000) Conventional ventilation versus high-frequency oscillation: hemodynamic effects in newborn babies. Crit Care Med 28:227–231PubMedCrossRef

33.

Cambonie G, Guillaumont S, Luc F, Vergnes C, Milesi C, Voisin M (2003) Haemodynamic features during high-frequency oscillatory ventilation in preterms. Acta Paediatr 92:1068–1073PubMedCrossRef

Title: Nasal continuous positive airway pressure decreases respiratory muscles overload in young infants with severe acute viral bronchiolitis
Authors: Gilles Cambonie
Christophe Milési
Samir Jaber
Francis Amsallem
Eric Barbotte
Jean-Charles Picaud
Stefan Matecki
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 10/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1201-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Nasal continuous positive airway pressure decreases respiratory muscles overload in young infants with severe acute viral bronchiolitis

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

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