Bronchiolitis is the most common cause of admission to the Paediatric Intensive Care Unit (PICU) for respiratory distress. The care of an infant with severe bronchiolitis is mainly based on symptomatic treatment (nutritional and respiratory support). The lower part of an infant's chest is larger than that of an older child, which can flatten the diaphragm, especially in obstructive disease with air trapping. Strapping the lower part (at the junction of the chest and abdomen) may provide a better condition for diaphragmatic contraction. Based on respiratory mechanics in infants and physiological studies in adults, investigators hypothesise that chest wall strapping may improve the ventilation and the diaphragmatic contraction. Infant \< 6 month with severe bronchiolitis admitted to the PICU will be recorded in 4 conditions with or without chest wall strapping and with a Continuous Positive Airway Pressure (CPAP) at 7 cmH2O or without CPAP. Physiological parameters (including work of breathing, respiratory parameters, distribution of ventilation) will be recorded and analysed.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
An elastic band (6 cm wide) is placed around the lower part of the chest wall (at the junction of the chest and abdomen) to tighten the chest wall for 10 min at PEEP 7 cmH2O and 10 min without PEEP
Réanimation pédiatrique
Bron, France
Esophagal product time pressure
Average over 100 consecutive cycles of esophageal product time pressure value
Time frame: 1 hour
Diaphragmatic product time pressure
Average over 100 consecutive cycles of diaphragmatic product time pressure value
Time frame: 1 hour
Esophagal and diaphragmatic swing
Mean on 100 breaths of the amplitude (maximum value -minimum value) of the esophageal pressure (cmH2O) and gastric pressure (cmH2O)
Time frame: 1 hour
Distribution of ventilation : center of ventilation
Mean over 1 minute of the center of the ventilation (%). Center of ventilation represents the average of the dorsal-ventral distribution of tidal variation using Electrical Impedance Tomography (values \>50% indicating that the center of ventilation is located in the ventral part of the chest)
Time frame: 1 hour
End expiratory lung volume
Average over 1 minute of the end expiratory lung impedance
Time frame: 1 hour
Time ratio
average over 100 consecutive cycles of inspiratory to aspiratory time ratio
Time frame: 1 hour
modified wood asthma score (mWCAS)
Value of the modified wood asthma score at the end of the recording period in each condition. Minimal value 0 and maximal value 10. A score ≥ 3 mean a moderate-to-severe respiratory distress.
Time frame: 1 hour
TcPCO2
Average of the transcutaneous CO2 (carbon dioxide) partial over 1 minute
Time frame: 1 hour
EDIN scale (Newborn Pain and Discomfort Scale)
Value of the EDIN score at the end of the recording period in each condition. Minimal value 0 and maximal value 15. EDIN scores \> 6 are considered expression of pain
Time frame: 1 hour
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