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

Byline: Gilles Cambonie (1,7), Christophe Milesi (1), Samir Jaber (2,6), Francis Amsallem (3), Eric Barbotte (4), Jean-Charles Picaud (1), Stefan Matecki (5,6) Keywords: Bronchiolitis; Continuous positive airway pressure; Infant; Respiratory effort; Respiratory syncytial virus infections; Respiratory therapy 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.sub.insp, two indices of inspiratory effort, were reduced by 54 (+-4)% and 59 (+-5)%. PTPgas.sub.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. Author Affiliation: (1) Pediatric Intensive Care Unit, CHU Montpellier, 34000, Montpellier, France (2) Intensive Care Unit and Transplantation Department, CHU Montpellier, 34000, Montpellier, France (3) Pediatric Pulmonology Unit, CHU Montpellier, 34000, Montpellier, France (4) Department of Medical Information, CHU Montpellier, 34000, Montpellier, France (5) Physiological Department, CHU Montpellier, 34000, Montpellier, France (6) INSERM ERI 25, Muscle and Pathologies, University Montpellier I, 34000, Montpellier, France (7) Unite de Reanimation-Pediatrique, CHU de Montpellier, Hopital Arnaud de Villeneuve, 371 Avenue du Doyen G. Giraud, 34295, Montpellier Cedex 5, France Article History: Registration Date: 24/06/2008 Received Date: 19/01/2008 Accepted Date: 15/06/2008 Online Date: 08/07/2008 Article note: This work was carried out in the Paediatric Intensive Care Unit, Hopital Arnaud de Villeneuve, CHU Montpellier, 34000 Montpellier, France.