Invasive ventilation in severe acute bronchiolitis

Abstract

Acute bronchiolitis is a very common viral disease in infants less than 1 year old. Since the introduction of non-invasive ventilation in the management of severe acute bronchiolitis, indications of mechanical ventilation are less frequent. However, mechanical ventilation remains essential in some serious situations such as the failure of non-invasive tools, acute respiratory failure or severe apnea. The clinical and pathophysiological spectrum of severe bronchiolitis can vary between two extremes, which may overlap, the obstructive component and the restrictive component, on which the indication of mechanical ventilation and the modality used must be well appreciated. In the case of mechanical ventilation, a number of fundamental principles of respiratory physiology and gas exchange must be respected. Furthermore, the management of ventilated children with severe bronchiolitis requires a deep valuation of mechanical ventilation's potential risks. Through this study and after a review of more than sixty articles, we propose to draw up the clinical, para-clinical profile of ventilated patients in case of severe acute bronchiolitis and describe management principles and mortality factors.