Prone Position in Acute Bronchiolitis

NCT ID: NCT03976895

Last Updated: 2021-10-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

452 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-13

Study Completion Date

2022-11-30

Brief Summary

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Acute viral bronchiolitis is the leading cause of community-acquired acute respiratory failure in developed countries (20 000 to 30 000 hospitalizations each year in France). Between 5% and 22% of these children are hospitalized in a critical care unit to benefit from a respiratory support.

Non-invasive ventilation, in particular the nasal Continuous Positive Airway Pressure (nCPAP), reduces the work of breathing in children with bronchiolitis and is associated with decreased morbidity and hospitalization costs compared with invasive ventilation. Nowadays, this technique is considered as the gold standard in the pediatric intensive care units (PICU) in France. High Flow Nasal Cannula (HFNC) has been proposed as an alternative to the nCPAP because of its better tolerance and simplicity of implementation. However, the proportion of failure remains high (35 to 50%), providing only a partial response to the care of these children, especially prior to the PICU.

In a physiological study (NCT02602678, article published), it has been demonstrated that prone position (PP) decrease, by almost 50%, the respiratory work of breathing and improve the respiratory mechanics in infants hospitalized in intensive care units for bronchiolitis.

Investigators hypothesize that prone position, during High Flow Nasal Cannula (HFNC), would significantly reduce the use of non-invasive ventilation (nCPAP and others) or invasive ventilation, as compared to supine position during HFNC, in infants with moderate to severe viral bronchiolitis.

Detailed Description

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Conditions

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Acute Viral Bronchiolitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Supine position (SP)

Supine position (SP) combined with HFNC

Group Type OTHER

Supine position (SP)

Intervention Type PROCEDURE

Infants under high flow nasal cannula (HFNC) will be positioned in the supine position.

Patients may be positioned temporarily in lateral position between periods of supine position to limit ventilatory disorders, as it is usually done in critical care units during bronchiolitis.

Prone position (PP)

Prone position (SP) combined with HFNC

Group Type EXPERIMENTAL

Prone position (PP)

Intervention Type PROCEDURE

Infants under high flow nasal cannula (HFNC) will be placed in the prone position during at least 24 hours over the first 48 hours. The positioning will be standardized (chest on the bed plan and abdomen cleared) and children should be placed in the prone position immediately after randomization.

Patients may be positioned temporarily in lateral position between periods of prone position to limit ventilatory disorders, as it is usually done in critical care units during bronchiolitis.

Interventions

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Supine position (SP)

Infants under high flow nasal cannula (HFNC) will be positioned in the supine position.

Patients may be positioned temporarily in lateral position between periods of supine position to limit ventilatory disorders, as it is usually done in critical care units during bronchiolitis.

Intervention Type PROCEDURE

Prone position (PP)

Infants under high flow nasal cannula (HFNC) will be placed in the prone position during at least 24 hours over the first 48 hours. The positioning will be standardized (chest on the bed plan and abdomen cleared) and children should be placed in the prone position immediately after randomization.

Patients may be positioned temporarily in lateral position between periods of prone position to limit ventilatory disorders, as it is usually done in critical care units during bronchiolitis.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Infant under 6 months
* Hospitalized in critical care unit (continuous monitoring unit or intensive care unit)
* With a clinical diagnosis of acute viral bronchiolitis (criterion of the American Academy of Pediatrics 2014)
* m-WCAS score ≥ 3 and / or hypercapnic acidosis with pH \<7.35 and pCO2\> 50mmHg (6.7 kPa)
* Informed consent signed by at least one of the parents with oral consent of the other parent (and / or legal guardian) recorded in the medical file.

Exclusion Criteria

* Infant admitted with criteria for invasive or non-invasive ventilation (hypercapnic acidosis with pH \<7.25 without ventilatory support and/or hypoxia with impossibility of maintaining SpO2\> 92% whatever the FiO2 and/or more than 3 significant apneas per hour and/or severe consciousness disorder)
* Patient already positioned in the prone position before randomization
* Significant comorbidities with a history of respiratory pathology (bronchodysplasia with ventilatory support), Ear Nose and Throat pathology (pharyngolaryngomalacia) or neuromuscular and / or hemodynamically significant congenital heart disease.
* Contraindication to Prone position : recent abdominal surgery (laparoschisis or omphalocele) or recent sternotomy
* Patient who is not affiliated (or does not benefit from) to a national social security system
Maximum Eligible Age

6 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospices Civils de Lyon

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Réanimation pédiatrique et unité de surveillance continue - Hôpital Femme Mère Enfant - Hospices Civils de Lyon

Bron, , France

Site Status RECRUITING

CHU de Caen, Service de réanimation et surveillance continue pédiatrique

Caen, , France

Site Status NOT_YET_RECRUITING

CH CHAMBERY Unité de surveillance continue pédiatrique

Chambéry, , France

Site Status RECRUITING

Hôpital d'Enfants CHU de Dijon Service de réanimation pédiatrique

Dijon, , France

Site Status NOT_YET_RECRUITING

CH ANNECY GENEVOIS Unité de surveillance continue pédiatrique

Épagny, , France

Site Status RECRUITING

CH VILLEFRANCHE Service de pédiatrie néonatologie

Gleizé, , France

Site Status RECRUITING

CHU GRENOBLE Service de réanimation pédiatrique Hôpital Couple Enfant

La Tronche, , France

Site Status RECRUITING

CHU MONTPELLIER Service de réanimation pédiatrique

Montpellier, , France

Site Status RECRUITING

CHU Nantes Unité de surveillance continue pédiatrique Hôpital mère-enfant

Nantes, , France

Site Status RECRUITING

CHU LENVAL NICE Service de réanimation pédiatrique

Nice, , France

Site Status RECRUITING

Hôpital Necker Enfant Malade, Paris Service de Réanimation et surveillance continue médicochirurgicales

Paris, , France

Site Status RECRUITING

CHU SAINT-ETIENNE Service de réanimation pédiatrique

Saint-Priest-en-Jarez, , France

Site Status RECRUITING

CRHU Nancy Réanimation Pédiatrique Spécialisée

Vandœuvre-lès-Nancy, , France

Site Status NOT_YET_RECRUITING

Countries

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France

Central Contacts

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Florent BAUDIN, Dr

Role: CONTACT

04 72 12 97 35 ext. +33

Tiphanie GINHOUX

Role: CONTACT

04 27 85 77 23 ext. +33

Facility Contacts

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Florent BAUDIN, Dr

Role: primary

04 72 12 97 35 ext. +33

Tiphanie GINHOUX

Role: backup

04 27 85 77 23 ext. +33

BROSSIER David

Role: primary

Corinne PAGET

Role: primary

04 79 96 61 60 ext. +33

NALLET-AMATE Megan

Role: primary

Clémence JARASSE

Role: primary

04 50 63 63 24 ext. +33

Marie TOCHON TEIXEIRA

Role: primary

04 74 09 28 39 ext. +33

Guillaume MORTAMET

Role: primary

04 76 76 55 03 ext. +33

Christophe MILESI

Role: primary

04 67 33 66 09 ext. +33

Jean Eudes PILOQUET

Role: primary

Mickael AFFANETI

Role: primary

04 92 03 04 08 ext. +33

Sylvain RENOLLEAU

Role: primary

01 44 49 56 67 ext. +33

François BARRIERE

Role: primary

04 77 82 83 85 ext. +33

WIEDEMANN Arnaud

Role: primary

Other Identifiers

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69HCL19_0333

Identifier Type: -

Identifier Source: org_study_id