Influence of intrapulmonary percussive ventilation in upright position on gastro-oesophageal reflux in infants

Prolonged Slow Expiration Technique and Gastroesophageal Reflux in Infants Under the Age of 1 Year

Background: The Prolonged Slow Expiration Technique (PSE) is an airway clearance technique (ACT) carried out in newborn children with bronchial obstruction and hypersecretion to clear away the mucus from the respiratory tract. Evidence about the effect of PSE on gastroesophageal reflux (GER) is currently lacking in the literature. This study aimed to evaluate the influence of PSE on GER in infants under the age of 1 year. Methods: Infants were observed using multichannel intraluminal impedance-pH monitoring (MII-pH) over 24 h. During monitoring, the participants were treated with one 20 min intervention of PSE in supine position, 2 h after feeding. In this controlled trial with intra-subject design, the number of reflux episodes (REs) during PSE were compared to 20 min before and after PSE. Results: Fifty infants younger than 1 year were screened of whom 22 had a pathological GER. For the entire group, no significant difference was seen in the total number of REs between before, during, or after the PSE treatment (P = 0.76). No significant difference in total REs was found between the three measuring points (P = 0.59) in the group of infants with an abnormal MII-pH (n = 22). Conclusion: PSE does not cause a significant difference in REs in infants younger than 1 year. Registration number: NCT03341585.

The influence of Intrapulmonary percussive ventilation on gastroesophageal reflux in infants under the age of 1 year

BACKGROUND

Intrapulmonary percussive ventilation (IPV) is an airway clearance technique used at any age to facilitate the removal of secretions from the respiratory tract. The effect of IPV on gastroesophageal reflux(GER) is not well documented. This study aimed to determine the influence of IPV on GER in infants.

METHODS

During a 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH), infants in the intervention group received a20 minutes session of IPV in upright position, 2 hours postprandial. The control group received no intervention and was placed in the same position for 20 minutes, 2 hours postprandial. The number of reflux episodes (REs) during IPV as compared to the number of REs in the control group during the 20 minutes period.

RESULTS

Fifty infants were included in each group;21 infants in the IPV group and 14 infants in the control group were diagnosed with abnormal MII-pH (P = .142). During IPV, the number of REs was significantly lower than in the control group (P < .001). Also in the subgroups with abnormal or normal MII-pH, a significantly lower number of REs during IPV was found (P = .011, P = .011 respectively).

CONCLUSION

IPV decreases the number of REs in infants independent of the results of MII-pH.

The effect of intrapulmonary percussive ventilation in pediatric patients: A systematic review

BACKGROUND

Intrapulmonary percussive ventilation (IPV) is frequently used in clinical practice to enhance sputum evacuation and lung recruitment. However, the evidence in different respiratory pathologies, especially in children, is still lacking. This systematic review aims to enlist the effectiveness of IPV as an airway clearance technique in pediatric patients.

DATA SOURCES

A systematic literature search was performed in PubMed, Web of Science, and the Cochrane Library databases.

STUDY SELECTION

Studies were included if the subjects suffered from a respiratory disease requiring airway clearance and the mean age of the sample was <18 years. After screening, nine articles remained for further analysis.

RESULTS

Three of the nine articles examined patients with cystic fibrosis (CF). No significant differences in lung function or expectorated mucus were found compared to conventional chest physiotherapy. On the other hand, significant beneficial results were found for the treatment or prevention of atelectasis in non-CF patients using IPV. Similar results were seen when comparing therapies for neuromuscular/neurological patients. One study found that IPV reduced hospital stay and improved the clinical status of children with acute bronchiolitis compared to no physiotherapy. Severe adverse events did not occur in the included studies.

CONCLUSION

A limited number of studies investigated IPV in the pediatric population. Despite the heterogeneity across the studies and the small sample sizes, the results seem promising. IPV is suggested to be a safe and effective alternative for airway clearance. Future research is required to confirm these results and to further analyze the possible benefits in different respiratory pathologies.

Influence of bouncing and assisted autogenic drainage on acid gastro-oesophageal reflux in infants

OBJECTIVES

To determine the influence of modern airway clearance techniques using assisted autogenic drainage (AAD), whether or not combined with bouncing, on acid gastro-oesophageal reflux (GOR) in infants <1 year.

METHODS

In this controlled trial with intra-subject design infants were studied using oesophageal pH monitoring over 24 h, during which they received one 15 min session of bouncing, AAD or bouncing combined with AAD (BAAD). The number of reflux episodes (RE) and the refluxindex (RI) were the outcome measures. The results obtained during (T15) and 15 min after the intervention (T30) were compared to a period of 15 min before treatment (T0).

RESULTS

The results of 150 infants, evenly distributed over the three treatment groups, were analyzed. No significant differences were found in number of RE at T15 and T30 compared to T0 in the bouncing group (P = 0.42), the AAD group (P = 0.14), and the BAAD group (P = 0.91). RI was significantly lower in the AAD group at T15 compared to T0 (P < 0.01). No differences in RI were found in the bouncing group (P = 0.28), nor in the BAAD group (P = 0.81).

CONCLUSION

Bouncing, AAD and BAAD do not induce, nor aggravate acid GOR in infants under the age of 1 year.

Effectiveness of airway clearance techniques in children hospitalized with acute bronchiolitis

OBJECTIVE

To evaluate the effectiveness of two airway clearance techniques (ACT's) in children <24 months hospitalized with mild to moderate bronchiolitis.

DESIGN

One hundred and three children were randomly allocated to receive one 20-min session daily, either assisted autogenic drainage (AAD), intrapulmonary percussive ventilation (IPV), or bouncing (B) (control group), ninety-three finished the study.

OUTCOME MEASURES

Mean time to recovery in days was our primary outcome measure. The impact of the treatment and the daily improvement was also assessed by a validated clinical and respiratory severity score (WANG score), heart rate (HR), and oxygen saturation (SaO₂ ).

RESULTS

Mean time to recovery was 4.5 ± 1.9 days for the control group, 3.6 ± 1.4 days, P < 0.05 for the AAD group and 3.5 ± 1.3 days, P = 0.03 for the IPV group. Wang scores improved significantly for both physiotherapy techniques compared to the control group.

CONCLUSION

Both ACT's reduced significantly the length of hospital stay compared to no physiotherapy. Pediatr Pulmonol. 2017;52:225-231. © 2016 Wiley Periodicals, Inc.