Using Nasal Broadband Glasses in the Initial Management of Severe Bronchiolitis in Infants Admitted in ICU (HFNC)

• Rate of early success for the number of bronchiolitis who once admitted in the ICU and placed HFNC will not need another support ventilation mode after one hour of treatment (H1) [ Time Frame: after one hour of treatment ]
  the number of children who once set HFNC at baseline Hour 0 will not need another breathing assistance technique After 1 hour H1 of treatment
  
  

• Overall success rate [ Time Frame: Comparaison between baseline Hour 0 and after 1 hour of treatment ]
  Number of children who will not need another technique while respiratory assistance throughout the ICU stay
  
  
• Predictive factors of failure of HFNC [ Time Frame: At baseline hour 0 ]
  Correlation of clinical and demographic data H0 to failure of HFNC
  
  
• The child's comfort HFNC [ Time Frame: comparison to H0, H1, H12 ]
  EDEN (pain scale and discomfort newborn) comfort Scores comparison to H0, H1, H12
  
  
• Incidence of adverse events in HFNC [ Time Frame: From baseline hour 0 to the end of hospitalization ]
  Frequency and types of adverse events throughout the ICU hospitalization period
  
  
• Effectiveness of HFNC on reducing the work of breathing after 1 hour [ Time Frame: Comparaison between baseline Hour 0 and after 1 hour of treatment ]
  H0 and H1 evaluation criteria for assessing the change in clinical status including respiratory work HFNC
  
  

Bronchiolitis in infants is a common and potentially serious disease. It corresponds to an acute pulmonary disease and dyspnea usually viral (70 to 80% of Respiratory syncytial virus RSV in infants less than 1 year). It particularly affects infants under 2 years.

The 2001 consensus conference and bronchiolitis 2006 on the management clarified the criteria for hospitalization and simplified therapeutic attitudes. These conferences have highlighted the importance of humidification, the nasopharyngeal desobstruction for less severe forms of oxygen therapy and for others. Recent literature has also shown that the use of noninvasive ventilation type CPAP (Continuous Positive Airway Pressure) nasal or broadband nasal glasses (HFNC: High Flow Nasal canula) in severe forms possible to reduce the work of breathing of children with severe bronchiolitis and their use in studies "before / after" was accompanied by a significant decrease in the use of invasive ventilation.

The HFNC and nasal CPAP can deliver warmed humidified gas through a nasal interface, greatly improving the safety and efficacy of administering O2. These devices generate a continuous positive pressure in the airways, for decreasing the work of breathing. The sealing absence of the HFNC at the nasal interface improves patient comfort and avoiding nasal trauma, sometimes encountered with nasal CPAP interfaces.

The HFNC is a simple, effective and safe, commonly used in severe bronchiolitis admitted in ICU (Intensive Care Unit). However instead of this technique is not yet well defined.

The investigators assume that the use of HFNC in severe bronchiolitis in first line allows sufficient respiratory improvement to avoid recourse to other technical assistance ventilatory more binding.