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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PRONE-Supine | Experimental | We test the hypothesis that in infants with severe bronchiolitis, prone position reduces the work of breathing (WOB) and the intrinsic Positive End Expiratory Pressure (PEEP). |
|
| SUPINE - Prone | Experimental | We test the hypothesis that in infants with severe bronchiolitis, prone position reduces the work of breathing (WOB) and the intrinsic Positive End Expiratory Pressure (PEEP). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Supine then Prone position | Procedure | 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) |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 60 min |
| Measure | Description | Time Frame |
|---|---|---|
| Intrinsic PEEP | Mean on 10 breaths of the intrinsic positive end expiratory pressure in spontaneous ventilation | 60 min |
| Inspiratory:Expiratory Time Ratio | Mean on 100 breaths of the Inspiratory:Expiratory Time Ratio |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospices Civils de Lyon | Bron | 69500 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30448014 | Result | Baudin F, Emeriaud G, Essouri S, Beck J, Portefaix A, Javouhey E, Guerin C. Physiological Effect of Prone Position in Children with Severe Bronchiolitis: A Randomized Cross-Over Study (BRONCHIO-DV). J Pediatr. 2019 Feb;205:112-119.e4. doi: 10.1016/j.jpeds.2018.09.066. Epub 2018 Nov 14. |
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| ID | Term |
|---|---|
| D001988 | Bronchiolitis |
| D018467 | Positive-Pressure Respiration, Intrinsic |
| ID | Term |
|---|---|
| D001991 | Bronchitis |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
| D001982 | Bronchial Diseases |
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| Prone then supine position | Procedure | 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) |
|
| 60 min |
| Heart rate | Evolution of the clinical and oxygenation parameter within the first hour in each position. | 60 min |
| Respiratory rate | Evolution of the clinical and oxygenation parameters within the first hour in each position. | 60 min |
| SPO2 | Evolution of the clinical and oxygenation parameters within the first hour in each position. | 60 min |
| Transcutaneous CO2 | Evolution of the clinical and oxygenation parameters within the first hour in each position. | 60 min |
| EDIN score (neonatal pain and discomfort scale) | 60 min |
| D012140 |
| Respiratory Tract Diseases |
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012131 | Respiratory Insufficiency |
| D012120 | Respiration Disorders |