RT Journal Article
SR Electronic
T1 Intrapulmonary Percussive Ventilation and Assisted Autogenic Drainage as Adjunctive Protocols Following Neonatal Mechanical Ventilation Discontinuation
JF Respiratory Care
FD American Association for Respiratory Care
SP 3951257
VO 68
IS Suppl 10
A1 Graczyk, Michelle
A1 Marietta, Ramey
A1 Gonzalez, Vanessa
A1 Green, Toni
A1 Munroe, Cheyenne
A1 Jeffrey, Dominique
A1 Lawal, Josephine
A1 Bougateff, Adel
A1 Restrepo, Ruben D
YR 2023
UL http://rc.rcjournal.com/content/68/Suppl_10/3951257.abstract
AB Background: Intrapulmonary Percussive Ventilation (IPV) and Autogenic Drainage (AD) are well known airway clearance techniques. Their safety and effectiveness have been well documented in the treatment of patients with cystic fibrosis, neuromuscular disease, and in the management of atelectasis in pediatric patients.However, to the best of our knowledge, IPV has not been assessed for airway clearance in the premature newborn following discontinuation of mechanical ventilation nor has been compared to AD in this population. This study was aimed to compare IPV to AD and determine their efficacy in preventing postextubation atelectasis and improvement of gas exchange in premature neonates. Methods: Prospective, randomized, controlled study of premature neonates who were intubated and mechanically ventilated for more than 72 hours. Patients were randomized at extubation to AD or IPV at frequencies of 200-300 cycles/min and pressures 5-10 cm H2O. Both treatments were given every 6 hours and lasted 15 min. Chest radiographs were evaluated by pediatric radiologist with no evidence of atelectasis prior to extubation in both groups. Results: Sixty premature newborns were included in the study. Mean gestational age was 29.3 ± 1.5 weeks and birth weight 1308 ± 259 g. There was a significant difference between groups in regard to presence of post-extubation atelectasis and need for reintubation (P < 0.05). Among the AD patients, seven (23%) developed post extubation atelectasis and four (13%) required reintubation for the resolution of the atelectasis. None of the patients receiving IPV developed post extubation atelectasis or required reintubation. The total duration of oxygen requirement after extubation, was 21.4 ± 12 days in AD group, and 15.7 ± 12 days in IPV group (P < 0.05). No significant differences were noted before therapy sessions in respect to heart rate, breathing frequency, PaO2, PaCO2, SaO2, and FIO2 between AAD and IPV allocated patients. However, when the same variables were compared between groups after therapy sessions, there were statistically significant differences (P < 0.05). Conclusions: This study suggests that intrapulmonary percussive ventilation could be effective in preventing post extubation atelectasis in this group of premature newborns. It can also improve gas exchange, reduce oxygen requirements and the duration of oxygen therapy after extubation.