The Science Journal of the American Association for Respiratory Care
INTRODUCTION: Intrapulmonary Percussive Ventilation (IPV) is a therapeutic modality designed to promote mobilization and facilitate the removal of retained secretions, re-expand areas of collapse, increase deposition of aerosolized particles, and improve gas exchange. IPV is ordered routinely at our institution for treatment of atelectasis as an adjunct or alternative to conventional chest physiotherapy. However, there are no published clinical practice guidelines that would identify either clear indications or expected outcomes for this treatment. The purpose of this pilot study was to determine if IPV was associated with any objective evidence of clinical improvement.
Methods: This retrospective study evaluated 46 pediatric patients in the pediatric intensive care unit, rehabilitation unit, and acute care areas from November 1996 through March 1999, who had radiographic evidence of atelectasis. Patients received IPV therapy (Intrapulmonary Percussionator Ventilator, IPV-1, F.M. Bird Corp) at frequencies of 180-220 cycles per minute at pressures of 15-30 cm H20, using 2.5 mg Albuterol and 6 mL normal saline. Chest radiographs were evaluated by a pediatric radiologist prior to IPV therapy and after it was discontinued. The following scoring system was used: 4 = complete collapse of two or more segments or lobes, 3 = complete collapse of one segment or lobe, 2 = partial collapse of two or more segments or lobes, 1 = partial collapse of one or segment or lobe and, 0 = complete resolution of collapse. Differences in median values before and after treatment were compared with the Mann-Whitney Rank Sum Test with significance set at p
Results: The median age of patients studied was 4.2 years (range 1 month to 15 years). Ninety percent of them had artificial airways, the rest had IPV delivered by mask. The median duration of IPV treatment was 6.2 days. There was a significant improvement in radiology score from 3 to 1 (p < 0.001).
CONCLUSION: This pilot study has shown that IPV is associated with a significant and clinically important improvement in atelectasis. However, it is unclear whether IPV treatment altered the natural resolution of atelectasis. These data justify a further, controlled study comparing IPV with conventional chest physiotherapy.