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Theses

Evaluation du travail respiratoire dans l'insuffisance respiratoire aigue de l'enfant

Abstract : Acute respiratory failure is the leading cause of hospital admissions in the pediatric intensive care unit and is associated with significant morbidity and mortality. Since the pediatric population is characterized by a great heterogeneity in terms of age and respiratory pathology, individualization of therapeutic management is essential. Different minimally invasive methods have been described to assess the patient's work of breathing in acute respiratory failure.Objectives - The main objective of the project was to assess the diagnostic and therapeutic contribution of the measurement of the work of breathing in children with acute hypercapnic respiratory failure.Methods - We used in the present work three tools to assess the work of breathing: oesogastric pressures, electrical activity of the diaphragm monitoring and oxygen consumption measurements.Results - We highlighted how these different methods are valuable during the ICU stay: (i) in the early phase of the disease to initiate or withdraw noninvasive ventilation and to optimize its settings; (ii) in the recovery phase to evaluate the patient-ventilator interaction; (iii) during the weaning process to early detect an increase in work of breathing.Conclusion - Throughout the disease process, the work of breathing assessment can be useful to enhance our understanding of the pathophysiology of lung disease, to optimize mechanical ventilation settings and adapt therapeutic interventions.
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Submitted on : Friday, November 30, 2018 - 2:16:06 PM
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Guillaume Mortamet. Evaluation du travail respiratoire dans l'insuffisance respiratoire aigue de l'enfant. Médecine humaine et pathologie. Université Paris-Est, 2018. Français. ⟨NNT : 2018PESC0010⟩. ⟨tel-01940670⟩

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