[697] Acute Pulmonary Diseases and Congenital Cardiac Pathologies

In our Neonatal and Pediatric Intensive Care Unit research activities are chiefly concentrated on two major fields: 1. acute pulmonary diseases, particularly in relation to artificial mechanical ventilation and 2. congenital cardiac pathologies, whose principal axe is centered on cardiopulmonary interactions in relation to new modes and strategies of mechanical ventilation for children and neonates.

 Several studies are actually underway or in preparation:

1.“Work of Breathing” study in children under non-invasive ventilation suffering from acute bronchiolitis:

This prospective study aims to analyze the respiratory mechanics and gas exchange under non-invasive ventilation (nasal CPAP) in relation to the various levels of CPAP-pressure applied. Respiratory mechanics will be assessed by measuring work of breathing, thoraco-abdominal synchronization, and gas exchange parameters. The object of this study is to try to define the optimal pressure level for supporting spontaneous breathing .

2. Study of non-invasive nasal high frequency oscillation in neonates with moderate respiratory insufficiency:

 Prospective study aiming to study the feasibility of nasal high frequency oscillation in the neonate or premature infant suffering from infant respiratory distress syndrome.

3. Study aiming at the optimization of pulmonary recruitment during conventional mechanical ventilation:

This prospective study, which is currently under preparation for submission to the Ethical Committee, will focus on functional lung recruitment in patients with an acute pulmonary pathology.  For many years, we have worked in the field of lung recruitment using conventional ventilation modes mainly in the animal laboratories. We use for many years with great success,  in terms of patient outcomes,  lung recruitment strategies during high-frequency oscillation. With this study we will now investigate the integration of recruitment in a structured way in patients under conventional mechanical ventilation. The aim is to be able to define “simple” physiological bedside parameters, which could be useful for finding optimal lung volumes (point of best recruitment and least over-distention) for each individual patient.

4. Study: Utility of non-invasive measurements to monitor bedside cardio-pulmonary interactions in patients under mechanical ventilation:

This study, in collaboration with the Pediatric Cardiology Unit, aims at evaluating the value of clinical and non-invasively measured parameters, validated by invasive hemodynamic parameters, for estimation of intra-vascular volume in relation of ventilator settings and changes of ventilator parameters.

Studies in collaboration with other international centers:

1. Study: Development of an Electrical Impedance Tomography system suitable for       bedside application in neonates:

This study of the development of a simplified method of EIT  method is done in collaboration with Prof. Simbrunner of the University of Innsbruck, Austria. This research activity will be centered on two fields: 1. development and application of the method in the animal model and 2. validation of this new method in the newborn child under spontaneous ventilation as well as under mechanical ventilation.

2. PALIVE-1 Study

Epidemiological study on an international scale in collaboration with the PALISI Group (Pediatric Acute Lung Injury and Sepsis Investigation Group). The object of this study is to analyze the attitudes and the methods for ventilating patients with acute pulmonary lesions on a global level, that is to say in the United States and in Europe

3.   European Neonatal Ventilation Survey Study

Epidemiological prospective study in collaboration with Dr Anton van Kaam of the Amsterdam Medical Center, Netherlands, which aims at collecting data on the use of invasive and non-invasive mechanical ventilation in at term neonates and very premature babies.

 

Group Publications