Advertisement

Intensive Care Medicine

, 34:1608 | Cite as

Non-invasive ventilation as primary ventilatory support for infants with severe bronchiolitis

  • Etienne JavouheyEmail author
  • Audrey Barats
  • Nathalie Richard
  • Didier Stamm
  • Daniel Floret
Original

Abstract

Objective

To report our experience of non-invasive ventilation (NIV) as primary ventilatory support strategy in infants admitted for severe bronchiolitis.

Design and setting

Retrospective study in a paediatric intensive care unit of an university hospital.

Patients

Infants aged less than 12 months, admitted for bronchiolitis during 2003–2004 and 2004–2005 winter epidemics.

Intervention

NIV was used as the primary ventilatory support during the second winter (NIV period), whereas invasive ventilation (IV) was the only support employed during the first winter (IV period). NIV consisted in either continuous positive airway pressure (CPAP from 5 to 10 cmH2O) or bilevel positive airway pressure (inspiratory pressure from 12 to 18 cmH2O) with a nasal mask.

Results

During the IV period, 53 infants were included, compared to 27 during the NIV period. The two groups did not differ in age or in number of premature births. Children in NIV group had less apnoea on admission. The intubation rate was reduced during NIV period (p < 0.001). No children had ventilator-associated pneumonia (VAP) during NIV period compared to nine during IV period (p < 0.05). In the NIV group, 10 infants (37%) required supplemental oxygen for more than 8 days compared to 33 children (65%) in IV group (p < 0.05). The length of hospital stay and the duration of ventilation were similar.

Conclusions

In this retrospective study, the use of NIV decreased the rate of ventilator associated pneumonia and reduced the duration of oxygen requirement without prolonging the hospital stay.

Keywords

Bronchiolitis Non-invasive ventilation Pulmonary infection Children Duration of ventilation 

Supplementary material

134_2008_1150_MOESM1_ESM.doc (25 kb)
MOESM1 (DOC 25 kb)

References

  1. 1.
    American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, the Société de Réanimation de Langue Française (2001) International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute Respiratory failure. Am J Respir Crit Care Med 163:283–291Google Scholar
  2. 2.
    Bersten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ (1991) Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 325:1825–1830PubMedGoogle Scholar
  3. 3.
    Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F et al. (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822PubMedCrossRefGoogle Scholar
  4. 4.
    Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA (2005) Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 294:3124–3130PubMedCrossRefGoogle Scholar
  5. 5.
    Duttweiler L, Nadal D, Frey B (2004) Pulmonary and systemic bacterial co-infections in severe RSV bronchiolitis. Arch Dis Child 89:1155–1157PubMedCrossRefGoogle Scholar
  6. 6.
    Girou E, Schortgen F, Delclaux C, Brun-Buisson C, Blot F, Lefort Y, Lemaire F, Brochard L (2000) Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA 284:2361–2367PubMedCrossRefGoogle Scholar
  7. 7.
    Colom AJ, Teper AM, Vollmer WM, Diette GB (2006) Risk factors for the development of bronchiolitis obliterans in children with bronchiolitis. Thorax 61:503–506PubMedCrossRefGoogle Scholar
  8. 8.
    Black AE, Hatch DJ, Nauth-Misir N (1990) Complications of nasotracheal intubation in neonates, infants and children: a review of 4 years’ experience in a children’s hospital. Br J Anaesth 65:461–467PubMedCrossRefGoogle Scholar
  9. 9.
    Rivera R, Tibballs J (1992) Complications of endotracheal intubation and mechanical ventilation in infants and children. Crit Care Med 20:193–199PubMedCrossRefGoogle Scholar
  10. 10.
    Fauroux B, Pigeot J, Polkey MI, Roger G, Boule M, Clement A, Lofaso F (2001) Chronic stridor caused by laryngomalacia in children: work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med 164:1874–1878PubMedGoogle Scholar
  11. 11.
    Essouri S, Nicot F, Clement A, Garabedian EN, Roger G, Lofaso F, Fauroux B (2005) Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure. Intensive Care Med 31:574–580PubMedCrossRefGoogle Scholar
  12. 12.
    Bach JR, Niranjan V (2000) Spinal muscular atrophy type I: a noninvasive respiratory management approach. Chest 117:1100–1105PubMedCrossRefGoogle Scholar
  13. 13.
    Bernet V, Hug MI, Frey B (2005) Predictive factors for the success of noninvasive mask ventilation in infants and children with acute respiratory failure. Pediatr Crit Care Med 6:660–664PubMedCrossRefGoogle Scholar
  14. 14.
    Fortenberry JD, Del Toro J, Jefferson LS, Evey L, Haase D (1995) Management of pediatric acute hypoxemic respiratory insufficiency with bilevel positive pressure (BiPAP) nasal mask ventilation. Chest 108:1059–1064PubMedCrossRefGoogle Scholar
  15. 15.
    Essouri S, Chevret L, Durand P, Haas V, Fauroux B, Devictor D (2006) Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit. Pediatr Crit Care Med 7:329–334PubMedCrossRefGoogle Scholar
  16. 16.
    Padman R, Lawless ST, Kettrick RG (1998) Noninvasive ventilation via bilevel positive airway pressure support in pediatric practice. Crit Care Med 26:169–173PubMedCrossRefGoogle Scholar
  17. 17.
    Leclerc F, Scalfaro P, Noizet O, Thumerelle C, Dorkenoo A, Fourier C (2001) Mechanical ventilatory support in infants with respiratory syncytial virus infection. Pediatr Crit Care Med 2:197–204PubMedCrossRefGoogle Scholar
  18. 18.
    Soong WJ, Hwang B, Tang RB (1993) Continuous positive airway pressure by nasal prongs in bronchiolitis. Pediatr Pulmonol 16:163–166PubMedCrossRefGoogle Scholar
  19. 19.
    McNamara F, Sullivan CE (1997) Nasal CPAP treatment in an infant with respiratory syncytial virus-associated apnea. Pediatr Pulmonol 24:218–221PubMedCrossRefGoogle Scholar
  20. 20.
    Pirret AM, Sherring CL, Tai JA, Galbraith NE, Patel R, Skinner SM (2005) Local experience with the use of nasal bubble CPAP in infants with bronchiolitis admitted to a combined adult/paediatric intensive care unit. Intensive Crit Care Nurs 21:314–319PubMedCrossRefGoogle Scholar
  21. 21.
    Kristensen K, Dahm T, Frederiksen PS, Ibsen J, Iyore E, Jensen AM, Kjaer BB, Olofsson K, Pedersen P, Poulsen S (1998) Epidemiology of respiratory syncytial virus infection requiring hospitalization in East Denmark. Pediatr Infect Dis J 17:996–1000PubMedCrossRefGoogle Scholar
  22. 22.
    Beasley JM, Jones SE (1981) Continuous positive airway pressure in bronchiolitis. Br Med J (Clin Res Ed) 283:1506–1508CrossRefGoogle Scholar
  23. 23.
    Thia LP, McKenzie SA, Blyth TP, Minasian CC, Kozlowska WJ, Carr SB (2007) Randomised controlled trial of nasal continuous positive airways pressure (CPAP) in bronchiolitis. Arch Dis Child 93:45–47PubMedCrossRefGoogle Scholar
  24. 24.
    Campion A, Huvenne H, Leteurtre S, Noizet O, Binoche A, Diependaele JF, Cremer R, Fourier C, Sadik A, Leclerc F (2006) Non-invasive ventilation in infants with severe infection presumably due to respiratory syncytial virus: feasibility and failure criteria. Arch Pediatr 13:1404–1409PubMedCrossRefGoogle Scholar
  25. 25.
    Larrar S, Essouri S, Durand P, Chevret L, Haas V, Chabernaud JL, Leyronnas D, Devictor D (2006) Effects of nasal continuous positive airway pressure ventilation in infants with severe acute bronchiolitis. Arch Pediatr 13:1397–1403PubMedCrossRefGoogle Scholar
  26. 26.
    Barats A, Javouhey E, Richard N, Stamm D, Floret D (2006) Non-invasive ventilation in infants with severe bronchiolitis. In: 8th European pediatric conference in pediatric and neonatal ventilation, Montreux, Switzerland March 29–April 1 2006Google Scholar
  27. 27.
    Stagnara J, Balagny E, Cossalter B, Dommergues JP, Dournel C, Drahi E, Gauchez H, Guillot F, Javault D, Lagardère B, Le Masne A, Lesprit E, Maidenberg M, Maufroy D, Picherot G, Renaud H, Undreiner F (2001) Management of bronchiolitis in the infant. Recommendations. Long text. Arch Pediatr 8(Suppl1):11S–23SPubMedCrossRefGoogle Scholar
  28. 28.
    Welliver RC (2003) Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection. J Pediatr 143:S112–S117PubMedCrossRefGoogle Scholar
  29. 29.
    Brochard L (2003) Mechanical ventilation: invasive versus noninvasive. Eur Respir J Suppl 47:31s–37sPubMedCrossRefGoogle Scholar
  30. 30.
    Antonelli M, Conti G, Rocco M, Bufi M, De Blasi RA, Vivino G, Gasparetto A, Meduri GU (1998) A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 339:429–435PubMedCrossRefGoogle Scholar
  31. 31.
    Almuneef M, Memish ZA, Balkhy HH, Alalem H, Abutaleb A (2004) Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance. Infect Control Hosp Epidemiol 25:753–758PubMedCrossRefGoogle Scholar
  32. 32.
    Tullu MS, Deshmukh CT, Baveja SM (2000) Bacterial nosocomial pneumonia in Paediatric Intensive Care Unit. J Postgrad Med 46:18–22PubMedGoogle Scholar
  33. 33.
    Thorburn K, Harigopal S, Reddy V, Taylor N, van Saene HK (2006) High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis. Thorax 61:611–615PubMedCrossRefGoogle Scholar
  34. 34.
    Kneyber MC, Blusse van Oud-Alblas H, van Vliet M, Uiterwaal CS, Kimpen JL, van Vught AJ (2005) Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract disease. Intensive Care Med 31:680–685PubMedCrossRefGoogle Scholar
  35. 35.
    Randolph AG, Reder L, Englund JA (2004) Risk of bacterial infection in previously healthy respiratory syncytial virus-infected young children admitted to the intensive care unit. Pediatr Infect Dis J 23:990–994PubMedCrossRefGoogle Scholar
  36. 36.
    Rello J, Paiva JA, Baraibar J, Barcenilla F, Bodi M, Castander D, Correa H, Diaz E, Garnacho J, Llorio M, Rios M, Rodriguez A, Sole-Violan J (2001) International conference for the development of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest 120:955–970PubMedCrossRefGoogle Scholar
  37. 37.
    Langley JM, Bradley JS (2005) Defining pneumonia in critically ill infants and children. Pediatr Crit Care Med 6:S9–S13PubMedCrossRefGoogle Scholar
  38. 38.
    Chevret L, Mbieleu B, Essouri S, Durand P, Chevret S, Devictor D (2005) Bronchiolitis treated with mechanical ventilation: prognosis factors and outcome in a series of 135 children. Arch Pediatr 12:385–390PubMedCrossRefGoogle Scholar
  39. 39.
    Navas L, Wang E, de Carvalho V, Robinson J (1992) Improved outcome of respiratory syncytial virus infection in a high-risk hospitalized population of Canadian children. Pediatric Investigators Collaborative Network on Infections in Canada. J Pediatr 121:348–354PubMedCrossRefGoogle Scholar
  40. 40.
    Kneyber MC, Brandenburg AH, de Groot R, Joosten KF, Rothbarth PH, Ott A, Moll HA (1998) Risk factors for respiratory syncytial virus associated apnoea. Eur J Pediatr 157:331–335PubMedCrossRefGoogle Scholar
  41. 41.
    Kneyber MC, Moons KG, de Groot R, Moll HA (2002) Prediction of duration of hospitalization in respiratory syncytial virus infection. Pediatr Pulmonol 33:453–457PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Etienne Javouhey
    • 1
    Email author
  • Audrey Barats
    • 2
  • Nathalie Richard
    • 1
  • Didier Stamm
    • 1
  • Daniel Floret
    • 1
  1. 1.Service de Réanimation Pédiatrique Hôpital Femme Mère Enfant, Groupement Hospitalier Est, 59 Boulevard Pinel, Hospices Civils de LyonUniversité Lyon 1Bron CedexFrance
  2. 2.Service de pédiatrie 2Hôpital HautepierreStrasbourgFrance

Personalised recommendations