Prone position reduces work of breathing in children with severe bronchiolitis. Baudin F., Emeriaud G., Essouri S., Beck J., Javouhey E., & Guerin C. 2017. abstract bibtex Introduction Acute viral bronchiolitis is a primary cause of respiratory distress in paediatric intensive care unit (ICU). Prone position (PP) is commonly used in neonates to improve respiratory mechanics and has been found beneficial to adult patients with acute respiratory distress syndrome. We aimed to evaluate the effect of PP on work of breathing as compared to supine position (SP) in children with severe bronchiolitis requiring non-invasive ventilation. Patients and methods The protocol was approved by our IRB (2015- A01200-49). Fourteen infants (9 boys) with median age 33 days [firstthird quartiles 25-58] with severe bronchiolitis requiring CPAP were included after written informed consent. Children were investigated in PP and SP each applied for 1 h in a random order with a washout period of 10 min between them. Level of CPAP was set at 7 cmH2O in both conditions. Oesophageal pressure probe was inserted orally (CTO-2 pressure transducer, Gaeltec, Scotland) to measure oesophageal pressure. Flow and airway pressure (Pmo in Fig. 15) were simultanuously recorded using a Neurovent data acquisition system (Neurovent Inc, Toronto, Canada). One hundred breaths were analyzed in each condition, in which work of breathing was estimated from oesophageal pressure-time product (PTPes) and oesophageal swings (Fig. 15). Data were expressed as median (first-third quartiles) and compared by using the Wilcoxon two-sample paired sign test. A p-value below 0.05 was considered significant. Results Respiratory rate was not different in PP and SP position (66 [46-78] vs 59 [52-77] breaths/minute, p = 0.40). Between PP and SP, the oesophageal PTP per breath was 3.5 [2.9-4.2] vs 4.6 [3.4- 5.1] cmH2O s, respectively, p = 0.048 and the swings of oesophageal pressure amounted to 9.3 [8.3-12.8] vs 14.9 [11.0-16.2] cmH2O, respectively, p = 0.035. Discussion Work of breathing estimated by using the oesophageal PTP and oesophageal swing was lower in PP than in SP in children who required non-invasive ventilation for severe bronchiolitis. This physiologic study suggests that PP may improve respiratory condition in children with severe bronchiolitis. Conclusion In children with severe bronchiolitis, the prone position decreased significantly the work of breathing compared to the supine position during non-invasive ventilation. (Figure Presented).
@misc{baudin_f._prone_2017,
title = {Prone position reduces work of breathing in children with severe bronchiolitis},
abstract = {Introduction Acute viral bronchiolitis is a primary cause of respiratory distress in paediatric intensive care unit (ICU). Prone position (PP) is commonly used in neonates to improve respiratory mechanics and has been found beneficial to adult patients with acute respiratory distress syndrome. We aimed to evaluate the effect of PP on work of breathing as compared to supine position (SP) in children with severe bronchiolitis requiring non-invasive ventilation. Patients and methods The protocol was approved by our IRB (2015- A01200-49). Fourteen infants (9 boys) with median age 33 days [firstthird quartiles 25-58] with severe bronchiolitis requiring CPAP were included after written informed consent. Children were investigated in PP and SP each applied for 1 h in a random order with a washout period of 10 min between them. Level of CPAP was set at 7 cmH2O in both conditions. Oesophageal pressure probe was inserted orally (CTO-2 pressure transducer, Gaeltec, Scotland) to measure oesophageal pressure. Flow and airway pressure (Pmo in Fig. 15) were simultanuously recorded using a Neurovent data acquisition system (Neurovent Inc, Toronto, Canada). One hundred breaths were analyzed in each condition, in which work of breathing was estimated from oesophageal pressure-time product (PTPes) and oesophageal swings (Fig. 15). Data were expressed as median (first-third quartiles) and compared by using the Wilcoxon two-sample paired sign test. A p-value below 0.05 was considered significant. Results Respiratory rate was not different in PP and SP position (66 [46-78] vs 59 [52-77] breaths/minute, p = 0.40). Between PP and SP, the oesophageal PTP per breath was 3.5 [2.9-4.2] vs 4.6 [3.4- 5.1] cmH2O s, respectively, p = 0.048 and the swings of oesophageal pressure amounted to 9.3 [8.3-12.8] vs 14.9 [11.0-16.2] cmH2O, respectively, p = 0.035. Discussion Work of breathing estimated by using the oesophageal PTP and oesophageal swing was lower in PP than in SP in children who required non-invasive ventilation for severe bronchiolitis. This physiologic study suggests that PP may improve respiratory condition in children with severe bronchiolitis. Conclusion In children with severe bronchiolitis, the prone position decreased significantly the work of breathing compared to the supine position during non-invasive ventilation. (Figure Presented).},
journal = {Annals of Intensive Care},
author = {{Baudin F.} and {Emeriaud G.} and {Essouri S.} and {Beck J.} and {Javouhey E.} and {Guerin C.}},
year = {2017},
keywords = {*bronchiolitis, *prone position, *work of breathing, Canada, Child, Scotland, breathing rate, clinical article, controlled study, esophagus pressure, female, human, information processing, informed consent, male, noninvasive ventilation, positive end expiratory pressure, pressure transducer, sign test, statistical significance, supine position}
}
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{"_id":"6cX2otaQX6DNtLiF3","bibbaseid":"baudinf-emeriaudg-essouris-beckj-javouheye-guerinc-pronepositionreducesworkofbreathinginchildrenwithseverebronchiolitis-2017","downloads":0,"creationDate":"2017-05-12T20:20:57.693Z","title":"Prone position reduces work of breathing in children with severe bronchiolitis","author_short":["Baudin F.","Emeriaud G.","Essouri S.","Beck J.","Javouhey E.","Guerin C."],"year":2017,"bibtype":"misc","biburl":"http://bibbase.org/zotero/gxu917","bibdata":{"bibtype":"misc","type":"misc","title":"Prone position reduces work of breathing in children with severe bronchiolitis","abstract":"Introduction Acute viral bronchiolitis is a primary cause of respiratory distress in paediatric intensive care unit (ICU). Prone position (PP) is commonly used in neonates to improve respiratory mechanics and has been found beneficial to adult patients with acute respiratory distress syndrome. We aimed to evaluate the effect of PP on work of breathing as compared to supine position (SP) in children with severe bronchiolitis requiring non-invasive ventilation. Patients and methods The protocol was approved by our IRB (2015- A01200-49). Fourteen infants (9 boys) with median age 33 days [firstthird quartiles 25-58] with severe bronchiolitis requiring CPAP were included after written informed consent. Children were investigated in PP and SP each applied for 1 h in a random order with a washout period of 10 min between them. Level of CPAP was set at 7 cmH2O in both conditions. Oesophageal pressure probe was inserted orally (CTO-2 pressure transducer, Gaeltec, Scotland) to measure oesophageal pressure. Flow and airway pressure (Pmo in Fig. 15) were simultanuously recorded using a Neurovent data acquisition system (Neurovent Inc, Toronto, Canada). One hundred breaths were analyzed in each condition, in which work of breathing was estimated from oesophageal pressure-time product (PTPes) and oesophageal swings (Fig. 15). Data were expressed as median (first-third quartiles) and compared by using the Wilcoxon two-sample paired sign test. A p-value below 0.05 was considered significant. Results Respiratory rate was not different in PP and SP position (66 [46-78] vs 59 [52-77] breaths/minute, p = 0.40). Between PP and SP, the oesophageal PTP per breath was 3.5 [2.9-4.2] vs 4.6 [3.4- 5.1] cmH2O s, respectively, p = 0.048 and the swings of oesophageal pressure amounted to 9.3 [8.3-12.8] vs 14.9 [11.0-16.2] cmH2O, respectively, p = 0.035. Discussion Work of breathing estimated by using the oesophageal PTP and oesophageal swing was lower in PP than in SP in children who required non-invasive ventilation for severe bronchiolitis. This physiologic study suggests that PP may improve respiratory condition in children with severe bronchiolitis. Conclusion In children with severe bronchiolitis, the prone position decreased significantly the work of breathing compared to the supine position during non-invasive ventilation. (Figure Presented).","journal":"Annals of Intensive Care","author":[{"firstnames":[],"propositions":[],"lastnames":["Baudin F."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Emeriaud G."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Essouri S."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Beck J."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Javouhey E."],"suffixes":[]},{"firstnames":[],"propositions":[],"lastnames":["Guerin C."],"suffixes":[]}],"year":"2017","keywords":"*bronchiolitis, *prone position, *work of breathing, Canada, Child, Scotland, breathing rate, clinical article, controlled study, esophagus pressure, female, human, information processing, informed consent, male, noninvasive ventilation, positive end expiratory pressure, pressure transducer, sign test, statistical significance, supine position","bibtex":"@misc{baudin_f._prone_2017,\n\ttitle = {Prone position reduces work of breathing in children with severe bronchiolitis},\n\tabstract = {Introduction Acute viral bronchiolitis is a primary cause of respiratory distress in paediatric intensive care unit (ICU). Prone position (PP) is commonly used in neonates to improve respiratory mechanics and has been found beneficial to adult patients with acute respiratory distress syndrome. We aimed to evaluate the effect of PP on work of breathing as compared to supine position (SP) in children with severe bronchiolitis requiring non-invasive ventilation. Patients and methods The protocol was approved by our IRB (2015- A01200-49). Fourteen infants (9 boys) with median age 33 days [firstthird quartiles 25-58] with severe bronchiolitis requiring CPAP were included after written informed consent. Children were investigated in PP and SP each applied for 1 h in a random order with a washout period of 10 min between them. Level of CPAP was set at 7 cmH2O in both conditions. Oesophageal pressure probe was inserted orally (CTO-2 pressure transducer, Gaeltec, Scotland) to measure oesophageal pressure. Flow and airway pressure (Pmo in Fig. 15) were simultanuously recorded using a Neurovent data acquisition system (Neurovent Inc, Toronto, Canada). One hundred breaths were analyzed in each condition, in which work of breathing was estimated from oesophageal pressure-time product (PTPes) and oesophageal swings (Fig. 15). Data were expressed as median (first-third quartiles) and compared by using the Wilcoxon two-sample paired sign test. A p-value below 0.05 was considered significant. Results Respiratory rate was not different in PP and SP position (66 [46-78] vs 59 [52-77] breaths/minute, p = 0.40). Between PP and SP, the oesophageal PTP per breath was 3.5 [2.9-4.2] vs 4.6 [3.4- 5.1] cmH2O s, respectively, p = 0.048 and the swings of oesophageal pressure amounted to 9.3 [8.3-12.8] vs 14.9 [11.0-16.2] cmH2O, respectively, p = 0.035. Discussion Work of breathing estimated by using the oesophageal PTP and oesophageal swing was lower in PP than in SP in children who required non-invasive ventilation for severe bronchiolitis. This physiologic study suggests that PP may improve respiratory condition in children with severe bronchiolitis. Conclusion In children with severe bronchiolitis, the prone position decreased significantly the work of breathing compared to the supine position during non-invasive ventilation. 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