Place de la ventilation non invasive nasale dans la prise en charge des broncho-alvéolites sévères

Abstract

Objective Usefulness of nasal continuous positive airway pressure (NCPAP) in severe acute bronchiolitis has been checked. The objective of this descriptive study was to evaluate the feasibility, safety and risk factors of NCPAP failure. Population and methods One hundred and forty-five infants were hospitalised in our intensive care unit during the 2 last epidemics (2003–2004, 2004–2005). Among them, 121 needed a respiratory support, either invasive ventilation ( N = 68) or NCPAP ( N = 53). Results General characteristics were similar during the 2 periods. Percentage of NCPAP failure, defined by tracheal intubation requirement during the stay in paediatric intensive care unit, was quite similar during the 2 periods (25%), but number of NCPAP increased twofold. Whatever the evolution was in the NCPAP group, we observed a significant decrease in respiratory rate (60 ± 16 vs 47.5 ± 13.7 cycle/min., P < 0.001) and PaCO 2 (64.3 ± 13.8 vs 52.6 ± 11.7 mmHg, P = 0.001) during NCPAP. Only PRISM calculated at day 1 and initial reduction of PaCO 2 were predictive of NCPAP failure. Percentage of ventilator associated pneumonia was similar (22%) between the invasive ventilation group and infants who where intubated because of failure of NCPAP. Duration of respiratory support and stay were reduced in the NCPAP group ( P < 0.002). Conclusion NCPAP appears to be a safe alternative to immediate intubation in infants with severe bronchiolitis.