B Fauroux

Publications (59)195.88 Total impact

• Article: Nocturnal hypoxaemia and hypercapnia in children with neuromuscular disorders.

  Chiara Bersanini, Sonia Khirani, Adriana Ramirez, Frédéric Lofaso, Guillaume Aubertin, Nicole Beydon, Michèle Mayer, Kim Maincent, Michèle Boulé, Brigitte Fauroux
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  ABSTRACT: The aim of the study was to identify daytime predictors of nocturnal gas exchange anomalies in children with neuromuscular disease (NMD) and normal daytime gas exchange. Lung function tests, respiratory muscle evaluation and nocturnal gas exchange were obtained as part of routine evaluation. We included 52 consecutive children with Duchenne muscular dystrophy (n = 20), spinal muscular atrophy (n = 10) and other NMD (n = 22). 20 patients had nocturnal hypoxaemia, defined as minimal arterial oxygen saturation measured by pulse oximetry (S(p,O(2))) <90% for ≥ 2% of night time, and 22 had nocturnal hypercapnia, defined as maximal transcutaneous carbon dioxide tension (P(tc,CO(2))) >50 mmHg for ≥ 2% of night time. Forced vital capacity and helium functional residual capacity correlated with minimal nocturnal S(p,O(2)) (p = 0.009 and p = 0.01, respectively). Daytime pH correlated negatively with maximal nocturnal P(tc,CO(2)) (p=0.005) and daytime arterial carbon dioxide tension (P(a,CO(2))) correlated with the percentage of time with a P(tc,CO(2)) >50 mmHg (p = 0.02). Sniff nasal inspiratory pressure correlated with minimal nocturnal S(p,O(2)) (p = 0.02). Daytime P(a,CO(2)) was a weak predictor of nocturnal hypercapnia (sensitivity 80%; specificity 57%). Daytime lung function and respiratory muscle parameters correlate poorly with nocturnal hypoxaemia and hypercapnia in children with NMD and normal daytime gas exchange, which necessitates more systematic sleep studies in these children.
  European Respiratory Journal 12/2011; 39(5):1206-12. · 5.89 Impact Factor
• Article: Why, when and how to propose noninvasive ventilation in cystic fibrosis?

  B Fauroux
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  ABSTRACT: Cystic fibrosis (CF) lung disease is characterized by progressive airflow obstruction, due to mucus plugging and inflammation within the bronchial walls, and destruction of the lung parenchyma secondary to bronchiectasis. These alterations result in an increase of the work of breathing, leading to alveolar hypoventilation predominantly during sleep, exercise and acute respiratory exacerbations. Noninvasive positive pressure ventilation (NPPV) has been shown to unload the respiratory muscles in patients with CF, which increases alveolar ventilation and improves gas exchange. NPPV has been shown to reduce oxygen desaturation during sleep, exercise and chest physiotherapy and may facilitate the recovery of a severe hypercapnic respiratory exacerbation. Several ventilatory modes may be used in cystic fibrosis patients but the most physiological mode is pressure support. However, validated criteria to start NPPV as well as data on long term outcome, notably in terms of improved survival and quality of life, are lacking and should be assessed in the future.
  Minerva anestesiologica 05/2011; 77(11):1108-14. · 2.66 Impact Factor
• Article: Daytime predictors of sleep-disordered breathing in neuromuscular patients to better schedule polysomnography.

  F Lofaso, B Fauroux, D Orlikowski, H Prigent
  European Respiratory Journal 02/2011; 37(2):231-2. · 5.89 Impact Factor
• Article: Effect of manufacturer-inserted mask leaks on ventilator performance.

  B Louis, K Leroux, D Isabey, B Fauroux, F Lofaso
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  ABSTRACT: Most pressure-support devices use a single circuit with an exhalation port integrated in the mask. The aim of the current study was to compare the effects of masks having different manufacturer-inserted leaks on ventilator performance. We simulated chronic obstructive pulmonary disease and restrictive disease. Four ventilators (VENTImotion (Weinmann, Hamburg, Germany), VPAP III STA (ResMed, Saint Priest, France), Synchrony 2 (Respironics, Nantes, France) and Vivo 40 (Breas, Saint Priest)) were tested with the recommended masks and with the masks having the largest and smallest leaks. Tests were performed with pressure support levels of 10, 15 and 20 cmH(2)O. The in vivo evaluation compared two ventilators using recommended masks opposed in terms of exhaled port resistance. The ventilators were tested with their recommended mask, and after mask exchange. The mask with the largest leak induced auto-triggering and/or increased inspiratory-trigger sensitivity was the VENTImotion under both simulated conditions and VPAP III STA under the simulated obstructive-disease condition. The mask with the smallest leak-increased inspiratory-trigger delay was Synchrony 2 in the simulated obstructive-disease condition and increased rebreathing. The in vivo study confirmed the bench results. When switching to a mask that has a different leak, evaluation is needed to adjust trigger sensitivity and pressurisation level and to check the absence of rebreathing.
  European Respiratory Journal 09/2009; 35(3):627-36. · 5.89 Impact Factor
• Article: [Noninvasive ventilation: interest and practical aspects in pediatric practice].

  S Essouri, P Durand, L Chevret, L Balu, B Fauroux, D Devictor
  Archives de Pédiatrie 07/2009; 16(6):721-2. · 0.30 Impact Factor
• Article: Exhaled nitric oxide in cystic fibrosis: relationships with airway and lung vascular impairments.

  D Hubert, F Aubourg, B Fauroux, L Trinquart, I Sermet, G Lenoir, A Clément, A T Dinh-Xuan, B Louis, B Mahut, C Delclaux
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  ABSTRACT: A reduction of exhaled nitric oxide (NO) fraction and endothelial-mediated dysfunction have been reported in cystic fibrosis (CF). The aims of the present study were to search for relationships between flow-independent NO exchange parameters (bronchial NO flux (J'(aw,NO)) and alveolar NO concentration (C(A,NO))) and lung function tests characterising airflow limitation and pulmonary vascular bed (capillary blood volume and physiological dead space/tidal volume (V(D)/V(T)) ratio on exercise). In total, 34 patients (16 children, 18 adults) with CF, without resting pulmonary hypertension, underwent spirometry, exhaled NO measurement (multiple constant flow analytical method), gas transfer assessment (carbon monoxide and NO, allowing the calculation of capillary volume and membrane conductance) and a graded exercise test with oxygen uptake (V'(O(2))), carbon dioxide production (V'(CO(2))) and arterial blood gas evaluations. Both J'(aw,NO) and C(A,NO )correlated positively with airflow limitation. C(A,NO) correlated positively with capillary/alveolar volume. During exercise, criteria of mild pulmonary vascular disease were evidenced in some patients that participated in exercise limitation (negative correlation between physiological V(D)/V(T) and peak V'(O(2))). C(A,NO )at rest correlated positively with these parameters of wasted ventilation during exercise (physiological V(D)/V(T), minute ventilation (V'(E))/V'(CO(2)) at ventilatory threshold and V'(E)/V'(CO(2)) slope). Flow-independent exhaled NO parameters are linked to airway and early vascular diseases in patients with CF.
  European Respiratory Journal 03/2009; 34(1):117-24. · 5.89 Impact Factor
• Article: [Pneumocystis jiroveci pneumonia during prolonged corticosteroid therapy in an immunocompetent infant].

  N Guillemot, S Blanchon, N Nathan, H Corvol, B Fauroux, G Aubertin, A Clement, R Epaud
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  ABSTRACT: Pneumocystis jiroveci (PJ) infection is rare in infants and is suggestive of primary or secondary immunodeficiency. We report on a case of severe PJ pneumonia in an immunocompetent infant after prolonged corticosteroid treatment. A 5 1/2 month-old girl presented with hypoxemic respiratory distress. Her medical record was remarkable only for a bulky parotid haemangioma, which was treated with prolonged oral corticosteroid therapy. The chest X-ray showed a mixed alveolar-interstitial pattern, and bronchoalveolar lavage revealed the presence of PJ. A favourable outcome was obtained after three weeks of intravenous trimethoprim-sulfamethoxazole treatment. PJ infection should be suspected in infants presenting with progressive respiratory distress associated with a mixed alveolar-interstitial pattern. Its potential seriousness justifies prophylactic therapy during prolonged immunosuppressive treatment (chemotherapy, corticosteroid treatment).
  Revue de Pneumologie Clinique 11/2008; 64(5):225-8. · 0.24 Impact Factor
• Article: Sniff nasal inspiratory pressure in children with muscular, chest wall or lung disease.

  B Fauroux, G Aubertin, E Cohen, A Clément, F Lofaso
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  ABSTRACT: Sniff nasal inspiratory pressure is proposed as a noninvasive test of inspiratory muscle strength. During this manoeuvre, the nasal pressure is supposed to reflect oesophageal pressure. The aim of the present study was to compare the nasal pressure with the oesophageal pressure during a maximal sniff in children with neuromuscular disease (NM, n = 78), thoracic scoliosis (n = 12) and cystic fibrosis (CF, n = 23). A significant correlation was observed between the sniff nasal and oesophageal pressure. The ratio of the sniff nasal/oesophageal pressure was lower in patients with CF (0.72+/-0.13) than in NM patients (0.83+/-0.17) or patients with thoracic scoliosis (0.86+/-0.10). In patients with CF and NM disease, this ratio was not correlated to age or spirometric data. The difference between the sniff oesophageal and nasal pressure exceeded 15 cm H(2)O in 17, 33 and 87% of the NM, thoracic scoliosis and CF patients, respectively. Sniff nasal pressure often underestimates the strength of inspiratory muscles in cystic fibrosis. Such an underestimation occurs more rarely in neuromuscular disease disorders and thoracic scoliosis. A normal value excludes inspiratory muscle weakness but a low value requires the measurement of the oesophageal pressure.
  European Respiratory Journal 10/2008; 33(1):113-7. · 5.89 Impact Factor
• Article: Performance of ventilators for noninvasive positive-pressure ventilation in children.

  B Fauroux, K Leroux, G Desmarais, D Isabey, A Clément, F Lofaso, B Louis
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  ABSTRACT: The aim of the present study was to evaluate the performance characteristics of all the ventilators proposed for home noninvasive positive-pressure ventilation in children in France. The ventilators (one volume-targeted, 12 pressure-targeted and four dual) were evaluated on a bench which simulated six different paediatric ventilatory patterns. For each ventilator, the quality of the inspiratory and expiratory trigger and the ability to reach and maintain the preset pressures and volumes were evaluated with the six patient profiles. The performance of the ventilators showed great variability, and depended upon the type of trigger (flow or pressure), type of circuit and patient profile. Differences were observed between the preset and measured airway pressure and between the tidal volume measured by the ventilator and on the bench. Leaks were associated with an inability to detect the patient's inspiratory effort or autotriggering. No single ventilator was able to adequately ventilate the six paediatric profiles. Only a few ventilators were able to ventilate the profiles simulating the youngest patients. A systematic paediatric bench evaluation is recommended for every ventilator proposed for home ventilation, in order to detect any dysfunction and guide the choice of the appropriate ventilator for a specific patient.
  European Respiratory Journal 07/2008; 31(6):1300-7. · 5.89 Impact Factor
• Article: [Sternal swelling in a nine-year-old child].

  N Guillemot, K Chadelat, N Nathan, G Aubertin, H Ducou le Pointe, A Clément, B Fauroux, R Epaud
  Médecine et Maladies Infectieuses 06/2008; 38(5):278-80. · 0.72 Impact Factor
• Article: [Malnutrition in children with chronic bronchitis].

  S Viola, M Boulé, P Tounian, L Huyn Thi Hong, M Medjadi, B Fauroux, J-P Girardet
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  ABSTRACT: To study nutritional status in children with chronic bronchitis (CB) in relation with lung function. In this cohort of study, 46 patients aged 6.0 to 17.5 years (mean: 11.9 years) with chronic bronchitis were recruited. None had cystic fibrosis. Body weight, height, skinfold thicknesses, percentage of ideal body weight-for-height (percentage of IBW), body mass index (BMI), BMI Z-score, fat mass and fat-free mass were used to evaluate nutritional status. Arterial blood gases, vital capacity (VC), forced expiratory volume in one s (FEV1), functional residual capacity (FRC) and maximum inspiratory (Pi(max)) and expiratory (Pe(max)) pressures at the mouth were used to evaluate respiratory function. Thirteen children (28%) had malnutrition defined as percentage of IBW lower than 90%, with a predominant fat mass depletion. VC (65+/-13% versus 79+/-15%; p=0.006) and FEV1 (59+/-16% versus 69+/-14%; p=0.03) were significantly lower in children with malnutrition than in children without malnutrition, but no significant differences were observed with regard to the FEV1/VC ratio and blood gases. Pi(max) (56+/-11% versus 88+/-37%, p=0,02) and Pe(max) (46+/-12% versus 58+/-19%, p=0,3) were also lower in children with malnutrition as compared to than without malnutrition. Malnutrition can be observed in children with CB and is associated with significant lower lung function parameters. This could be explained by decrease in respiratory muscle strength.
  Archives de Pédiatrie 06/2008; 15(8):1270-5. · 0.30 Impact Factor
• Source

  Available from: Nicolas Terzi

  Article: Measuring inspiratory muscle strength in neuromuscular disease: one test or two?

  N Terzi, D Orlikowski, C Fermanian, M Lejaille, L Falaize, A Louis, J-C Raphael, B Fauroux, F Lofaso
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  ABSTRACT: Inspiratory muscle strength monitoring is crucial in patients with neuromuscular disorders. The sniff nasal inspiratory pressure (SNIP) and maximal inspiratory pressure (P(I,max)) are usually measured. The present study investigated whether the test yielding the best value at baseline continued to yield the best value during follow-up. The present study included 25 patients with Duchenne muscular dystrophy (DMD) and 61 with myotonic muscular dystrophy (MMD). SNIP and P(I,max) were measured at baseline and then annually. At baseline, SNIP was lower than P(I,max) in 20 (80%) DMD patients and 32 (52%) MMD patients. During follow-up in DMD patients, changes in the best method always occurred from SNIP to P(I,max). In MMD patients, when SNIP was better than P(I,max) at baseline, SNIP was usually (88%) better during follow-up, whereas a better P(I,max) than SNIP at baseline was frequently (50%) followed by a shift to SNIP. Maximal inspiratory pressure may be sufficient for monitoring inspiratory muscle function in Duchenne muscular dystrophy adults. In myotonic muscular dystrophy, the marked variability in the test yielding the best value at baseline indicates a need for performance of both tests at baseline. However, when sniff nasal inspiratory pressure measurement yields the best value at baseline, using sniff nasal inspiratory pressure alone during follow-up may be appropriate.
  European Respiratory Journal 02/2008; 31(1):93-8. · 5.89 Impact Factor
• Article: Requisite for stringent control of oxygen therapy in the neonatal period.

  B Fauroux, A Clément
  European Respiratory Journal 02/2007; 29(1):4-5. · 5.89 Impact Factor
• Article: Long term effects of azithromycin in patients with cystic fibrosis: A double blind, placebo controlled trial.

  A Clement, A Tamalet, E Leroux, S Ravilly, B Fauroux, J-P Jais
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  ABSTRACT: Macrolides display immunomodulatory effects that may be beneficial in chronic inflammatory pulmonary diseases. The aim of the study was to document whether long term use of azithromycin may be associated with respiratory benefits in young patients with cystic fibrosis. A multicentre, randomised, double blind, placebo controlled trial was conducted from October 2001 to June 2003. The criteria for enrollment were age older than 6 years and forced expiratory volume in 1 second (FEV1) of 40% or more. The active group received either 250 mg or 500 mg (body weight < or > or =40 kg) of oral azithromycin three times a week for 12 months. The primary end point was change in FEV1. Eighty two patients of mean (SD) age 11.0 (3.3) years and mean (SD) FEV1 85 (22)% predicted were randomised: 40 in the azithromycin group and 42 in the placebo group. Nineteen patients were infected with Pseudomonas aeruginosa. The relative change in FEV1 at month 12 did not differ significantly between the two groups. The number of pulmonary exacerbations (count ratio 0.50 (95% CI 0.32 to 0.79), p < 0.005), the time elapsed before the first pulmonary exacerbation (hazard ratio 0.37 (95% CI 0.22 to 0.63), p < 0.0001), and the number of additional courses of oral antibiotics were significantly reduced in the azithromycin group regardless of the infectious status (count ratio 0.55 (95% CI 0.36 to 0.85), p < 0.01). No severe adverse events were reported. Long term use of low dose azithromycin in young patients with cystic fibrosis has a beneficial effect on lung disease expression, even before infection with Pseudomonas aeruginosa.
  Thorax 11/2006; 61(10):895-902. · 6.84 Impact Factor
• Article: Sniff nasal inspiratory pressure: what is the optimal number of sniffs?

  F Lofaso, F Nicot, M Lejaille, L Falaize, A Louis, A Clement, J-C Raphael, D Orlikowski, B Fauroux
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  ABSTRACT: Sniff nasal inspiratory pressure (SNIP) measurement is a volitional noninvasive assessment of inspiratory muscle strength. A maximum of 10 sniffs is generally used. The purpose of the present study was to investigate whether the maximum SNIP improved after the tenth sniff. In total, 20 healthy volunteers and 305 patients with various neuromuscular and lung diseases were encouraged to perform 40 and 20 sniffs, respectively. The best SNIP among the first 10 sniffs was lower than the best SNIP among the next 10 sniffs in the healthy volunteers and patients. The SNIP improvement after the twentieth sniff was marginal. In conclusion, a learning effect persists after the tenth sniff. The current authors suggest using 10 additional sniffs when the best result of the first 10 sniffs is slightly below normal, or when sniff nasal inspiratory pressure is used to monitor a progressive decline in inspiratory muscle strength.
  European Respiratory Journal 06/2006; 27(5):980-2. · 5.89 Impact Factor
• Article: Conservative use of chest-tube insertion in children with pleural effusion.

  R Epaud, G Aubertin, M Larroquet, H Ducou-le Pointe, P Helardot, A Clement, B Fauroux
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  ABSTRACT: The aim of this work was to evaluate the effect of a more conservative use of chest-tube insertion on the short-term and long-term outcome of pleural infection. Sixty-five patients with pleural infection, aged 1 month to 16 years were each treated according to one of the two protocols: classical management with chest-tube insertion (classical group, n = 33), or conservative use of chest-tube insertion (conservative group, n = 32), with drainage indicated only in the case of voluminous pleural effusion defined by a mediastinal shift and respiratory distress and/or an uncontrolled septic situation. The two groups were comparable with regard to age, baseline C-reactive protein (CRP) value and white blood cell counts, pleural thickness, identified bacteria, and antibiotic treatment. Chest-tube insertion was performed in 17 patients (52%) of the classical group compared to eight patients (25%) of the conservative group (P = 0.03). Duration of temperature above 39 degrees C was shorter in the conservative group (10 +/- 1 vs. 14 +/- 1 days, P = 0.01), as was the normalization of CRP (13 +/- 1 vs. 17 +/- 1 days, P = 0.03). Duration of hospitalization and intravenous (IV) antibiotherapy as well as the delay of chest-radiograph normalization was not significantly different between the two groups. A more conservative use of chest-tube insertion did not change short- and long-term outcome of the pleural infection in children. Drainage could be restricted to the most severely affected patients with pleural empyema causing a mediastinal shift and respiratory distress and/or presenting with an uncontrolled septic situation.
  Pediatric Surgery International 05/2006; 22(4):357-62. · 1.25 Impact Factor
• Source

  Available from: nih.gov

  Article: Non-invasive mechanical ventilation: when to start for what benefit?

  B Fauroux, F Lofaso
  Thorax 01/2006; 60(12):979-80. · 6.84 Impact Factor
• Article: Quality control of equipment in home mechanical ventilation: a European survey.

  R Farre, S J Lloyd-Owen, N Ambrosino, G Donaldson, J Escarrabill, B Fauroux, D Robert, B Schoenhofer, A Simonds, J A Wedzicha
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  ABSTRACT: Quality control of the equipment used in home mechanical ventilation is necessary in order to ensure that patients safely and accurately receive the prescribed ventilatory support. The aim of this study was to carry out a survey on the quality-control procedures in different centres and countries. The survey was carried out in the context of a European Commission Concerted Action covering 16 European countries. The study was extensive and detailed, involving 326 centres, which provided home ventilation to >20,000 patients. The survey showed that: 1) ventilator servicing was mainly carried out by external companies (62% of centres), with a servicing frequency ranging 3-12 months; 2) interaction between servicing companies and prescribers was limited (only 61% of centres were always informed of major incidents); 3) participation of centres in equipment quality control was poor (only 56% of centres assessed that patients/caregivers correctly cleaned/maintained the ventilator); and 4) centres were insufficiently aware of vigilance systems (only 23% of centres). Moreover, the data showed considerable inter- and intra-country differences. The size of the centre was an important determinant of many of these quality-control aspects. This survey provides information that will enable the European Commission Concerted Action to formulate recommendations on procedures for home-ventilator quality control.
  European Respiratory Journal 07/2005; 26(1):86-94. · 5.89 Impact Factor
• Article: Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey.

  S J Lloyd-Owen, G C Donaldson, N Ambrosino, J Escarabill, R Farre, B Fauroux, D Robert, B Schoenhofer, A K Simonds, J A Wedzicha
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  ABSTRACT: The study was designed to assess the patterns of use of home mechanical ventilation (HMV) for patients with chronic respiratory failure across Europe. A detailed questionnaire of centre details, HMV user characteristics and equipment choices was sent to carefully identified HMV centres in 16 European countries. A total of 483 centres treating 27,118 HMV users were identified. Of these, 329 centres completed surveys between July 2001 and June 2002, representing up to 21,526 HMV users and a response rate of between 62% and 79%. The estimated prevalence of HMV in Europe was 6.6 per 100,000 people. The variation in prevalence between countries was only partially related to the median year of starting HMV services. In addition, there were marked differences between countries in the relative proportions of lung and neuromuscular patients using HMV, and the use of tracheostomies in lung and neuromuscular HMV users. Lung users were linked to a HMV duration of <1 yr, thoracic cage users with 6-10 yrs of ventilation and neuromuscular users with a duration of > or =6 yrs. In conclusion, wide variations exist in the patterns of home mechanical ventilation provision throughout Europe. Further work is needed to monitor its use and ensure equality of provision and access.
  European Respiratory Journal 06/2005; 25(6):1025-31. · 5.89 Impact Factor
• Article: [Domiciliary non-invasive ventilation in children].

  B Fauroux, F Lofaso
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  ABSTRACT: Non-invasive positive pressure ventilation (NPPV) represents a particularly interesting technique of ventilatory support in paediatrics. Indeed, a significant number of pathologies that may be responsible for chronic respiratory insufficiency in childhood, such as neuromuscular diseases, obstruction of the upper airways, disorders of chest wall and/or the lungs, and disorders of ventilatory control may all lead to alveolar hypoventilation that can be improved by ventilatory support. Few physiological studies have been performed on NPPV in children. The most appropriate modes and settings for each pathology have not been clearly defined, and the criteria for commencing NPPV are based essentially on consensus guidelines for the management of neuromuscular disorders. All the health care professionals managing these children should combine their efforts to evaluate more precisely the medium and long-term physiological effects of NPPV on the respiratory muscles, the development of the respiratory system, inspiratory activity, the indications for starting treatment and, above all, the benefits in terms of psycho-neurological development and quality of life. A better evaluation of the medium and long-term physiological and psychological benefits together with technical improvements in ventilators and associated equipment should allow a rapid expansion in the use of domiciliary NPPV in children.
  Revue des Maladies Respiratoires 05/2005; 22(2 Pt 1):289-303. · 0.59 Impact Factor