Chest and Abdominal Wall Strapping in Infant With Bronchiolitis

Effect of Chest and Abdominal Wall Strapping on Ventilation and Work of Breathing in Infants With Severe Bronchiolitis: a Physiological Study

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.

Inclusion Criteria:

• Infant < 6 months
• Admitted to the PICU for less than 48 hours
• With a diagnosis of bronchiolitis
• With a respiratory distress sign (mWCAS ≥ 3) and non-invasive ventilatory support
• With a naso or oro gastric tube for feeding
• With written informed consent from parents or legal guardians

Exclusion Criteria:

• Infants with severe bronchopulmonary disease, severe laryngomalacia, neuromuscular disease, bone disease, cyanotic heart disease
• Contraindication to the use of a gastric tube
• recent abdominal or thoracic surgery
• investigator able to perform physiological recording not available
• Patient who is not affiliated (or does not benefit from) to a national social security system