Initiation de la ventilation non invasive aux urgences pédiatriques dans les bronchiolites sévères du nourrisson

INTRODUCTION: Nasal continuous positive airway pressure (nCPAP) in infants with acute severe bronchiolitis has rapidly developed both in paediatric intensive care units (PICUs) and during medicalized transport, since 2003. This study aims to verify the indications of nCPAP used in the paediatric emergency department (PED) at the Ambroise Paré Hospital compared to those used in the PICU and to evaluate the efficiency of nCPAP to stabilize the respiratory function of infants with acute severe bronchiolitis before medicalized transport to the PICU. PROCEDURE: A retrospective French study was conducted on infants with severe bronchiolitis ventilated by nCPAP in the PED at the Ambroise Paré Hospital, from winter 2009 to winter 2011. RESULTS: Out of the 31 infants, 16% were formerly prematurely born with otherwise no significant medical history. Postnatal age was 2 months. The rate of nCPAP performed for apneas (single indication of nCPAP for severe bronchiolitis according to the 2006 French medical consensus) was 17%. At least two indications of nCPAP used in the PICU were found for every patient. Babies were transferred within 2 h of nCPAP to the PICU. Clinical improvement was already observed with significantly slower respiratory rate and normalization of capnia and pH (P < 0.001) and without any complication at the PED. NCPAP was pursued in the PICU in 84% of the cases. The average duration of nCPAP was of 2.7 days, with the duration of hospitalization in the PICU of 4.2 days. CONCLUSION: The nCPAP is a useful respiratory support technique which is easy to implement in the PED.