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

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• 作者：Gilles Cambonie (1) (7)
  Christophe Milési (1)
  Samir Jaber (2) (6)
  Francis Amsallem (3)
  Eric Barbotte (4)
  Jean-Charles Picaud (1)
  Stefan Matecki (5) (6)
  
• 关键词：Bronchiolitis ; Continuous positive airway pressure ; Infant ; Respiratory effort ; Respiratory syncytial virus infections ; Respiratory therapy
• 刊名：Intensive Care Medicine
• 出版年：2008
• 出版时间：October 2008
• 年：2008
• 卷：34
• 期：10
• 页码：1865-1872
• 全文大小：240KB
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• 作者单位：Gilles Cambonie (1) (7)
  Christophe Milési (1)
  Samir Jaber (2) (6)
  Francis Amsallem (3)
  Eric Barbotte (4)
  Jean-Charles Picaud (1)
  Stefan Matecki (5) (6)
  
  1. Pediatric Intensive Care Unit, CHU Montpellier, 34000, Montpellier, France
  7. Unité de Réanimation-Pédiatrique, CHU de Montpellier, H?pital Arnaud de Villeneuve, 371 Avenue du Doyen G. Giraud, 34295, Montpellier Cedex 5, France
  2. Intensive Care Unit and Transplantation Department, CHU Montpellier, 34000, Montpellier, France
  6. INSERM ERI 25, Muscle and Pathologies, University Montpellier I, 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
  

文摘

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 PTPesinsp, two indices of inspiratory effort, were reduced by 54 (±4)% and 59 (±5)%. PTPgasexp, 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.