Ventilation mécanique dans les pathologies obstructives de l'enfant : physiopathologie des interventions ventilatoires et non ventilatoires

Abstract : Obstructive lung disease in children (asthma and bronchiolitis) are one of the main causes of admission to pediatric intensive care units. For several years, progress has been made to reduce the invasiveness of care resulting in a decrease in associated morbidity. The main objective of the thesis was to propose new ventilatory and non-ventilatory strategies based on physiopathology to optimize the care of such children.In children with severe bronchiolitis we evaluated the impact of prone position associated with non-invasive ventilation. The prone position decreases significantly the inspiratory work of breathing and improves the neuromechanical efficiency of the diaphragm. We also evaluated the effect of neurally adjusted ventilatory assist (NAVA) that is a proportional ventilatory mode based on the electrical activity of the diaphragm. We demonstrated that NAVA improved the patient-ventilator interactions and decrease the work of breathing in comparison with nasal continuous positive airway pressure (nCPAP). We also evaluated the feasibility of high flow nasal cannula as a respiratory support in children with severe asthma attack. These strategies need now to be validated on clinical outcomes and are the subject of two ongoing multicenter randomized trials
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Florent Baudin. Ventilation mécanique dans les pathologies obstructives de l'enfant : physiopathologie des interventions ventilatoires et non ventilatoires. Autre [q-bio.OT]. Université de Lyon, 2019. Français. ⟨NNT : 2019LYSE1056⟩. ⟨tel-02303044⟩

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