Acute viral bronchiolitis is the first cause of respiratory distress in infant. Airway inflammation increases the respiratory system resistances and dynamic hyperinflation. This leads to an increase in the work of breathing. In Chronic obstructive pulmonary disease patients as in neonates, prone position (PP) improves lung function and decreases the end expiratory lung volume. The investigators hypothesized that in infants with severe bronchiolitis, prone position reduces the intrinsic Positive End Expiratory Pressure (PEEPi) and the work of breathing (WOB). The investigator designed a prospective randomized crossover study with 16 infants younger than six months who need ventilatory support by nasal continuous positive airway pressure (nCPAP) for severe acute viral bronchiolitis. Work of breathing (product time pressure) and PEEPi will be estimated using an esophageal pressure probe in prone and supine position.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
16
One hour in supine position with CPAP (+7 cmH2O) then 15 min in supine position in spontaneous ventilation (wash-out) and one hour in prone position with CPAP (+7 cmH2O)
One hour in prone position with CPAP (+7 cmH2O) then 15 min in supine position in spontaneous ventilation (wash out ) and one hour in supine position with CPAP (+7 cmH2O)
Hospices Civils de Lyon
Bron, France
Work of breathing
The primary outcome is the work of breathing (WOB) estimated by the mean on 100 breaths of the esophageal and trans-diaphragmatic Pressure-Time Product (PTP) at the end of the first hour.
Time frame: 60 min
Intrinsic PEEP
Mean on 10 breaths of the intrinsic positive end expiratory pressure in spontaneous ventilation
Time frame: 60 min
Inspiratory:Expiratory Time Ratio
Mean on 100 breaths of the Inspiratory:Expiratory Time Ratio
Time frame: 60 min
Heart rate
Evolution of the clinical and oxygenation parameter within the first hour in each position.
Time frame: 60 min
Respiratory rate
Evolution of the clinical and oxygenation parameters within the first hour in each position.
Time frame: 60 min
SPO2
Evolution of the clinical and oxygenation parameters within the first hour in each position.
Time frame: 60 min
Transcutaneous CO2
Evolution of the clinical and oxygenation parameters within the first hour in each position.
Time frame: 60 min
EDIN score (neonatal pain and discomfort scale)
Time frame: 60 min
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