Please select the eligibility criteria that correspond to the clinical trial below.
Title: Prone Position Effects on Work of Breathing and Intrinsic PEEP in Children With Severe Acute Viral Bronchiolitis
Brief Summary: Acute viral bronchiolitis is the first cause of respiratory distress in infant. Airway inflammation increases the respiratory system resistances and dynamic hyperinflation. This leads to an increase in the work of breathing. In Chronic obstructive pulmonary disease patients as in neonates, prone position (PP) improves lung function and decreases the end expiratory lung volume. The investigators hypothesized that in infants with severe bronchiolitis, prone position reduces the intrinsic Positive End Expiratory Pressure (PEEPi) and the work of breathing (WOB). The investigator designed a prospective randomized crossover study with 16 infants younger than six months who need ventilatory support by nasal continuous positive airway pressure (nCPAP) for severe acute viral bronchiolitis. Work of breathing (product time pressure) and PEEPi will be estimated using an esophageal pressure probe in prone and supine position.


Options:
A: Inclusion Criteria:

1. Age ≥ 18 years
2. Patients expected to be oro-tracheally intubated for at least 48 hours or longer
3. Enrollment time window within 12 hours following intubation

Exclusion Criteria:

1. Current and past participation in an other intervention trial conflicting with the present study
2. Previous endotracheal intubation longer than 12 hours during the previous 30 days
3. Patients with documented bronchiectasis
4. Cystic fibrosis
5. Witnessed pulmonary aspiration either prior or at intubation
6. Patients with increased intracranial pressure, brain edema; or medical conditions that can worsen with increase in intracranial pressure
7. Patients with significant heart failure and activity impairment (Class III-IV of the New York Heart Association (NYHA)
8. Spinal cord injury
9. BMI \> 35, or weight above 300 pound
10. Grade IV Intra-abdominal pressure: IAP \> 25 mmHg or abdominal compartment syndrome , defined as a sustained IAP \> 20 mmHg that is associated with new organ dysfunction / failure
11. Pregnancy
12. Orthopedic problems that will not allow the patient to be kept in one of the study positions
B: Inclusion Criteria:

* Children undergoing general anesthesia with prone position
* Endotracheal intubation and mechanical ventilation during general anesthesia
* Operation time is more than 2 hours

Exclusion Criteria:

* Previous lung surgery
* Any abnormal findings such as atelectasis, pneumothorax, pleural effusion, or pneumonia on preoperative chest X-ray
* Researchers judge (to be inappropriate)
C: Inclusion Criteria:

* ARDS patient
* mechanically ventilated in prone position
* sedated and paralyzed
* with continuous cardiac output monitoring by transpulmonary thermodilution and pulse contour analysis
* fluid loading as indicated by attending physician

Exclusion Criteria:

* Age below 18
* no affiliation to social security
* Vena cava obstruction
* previous inclusion in protocol
D: Inclusion Criteria:

* Infant \< 6 months
* Admitted in the pediatric intensive care unit of the Femme-Mère-Enfant hospital, Hospices Civils de Lyon, France
* With severe acute viral bronchiolitis requiring ventilatory support (mWCAS \> 4 and/or and or FiO2\> 40% and/or hypercapnic acidosis (pH\<7.30 and/or pCO2\>8 kPa))
* Signed informed consent by the two parents or the owner of parental authority

Exclusion Criteria:

* Chronic respiratory, neuromuscular, ENT or cardiac disease
* Contraindication for placement of esophageal probe (esophageal surgery, varices, ...)
* Children requiring invasive ventilation (more than 3 significant apneas in 1 hour, decreased consciousness, ...)
* Children not affiliated to a social security scheme

Answer: D