The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

PILOT COMPARISON OF POSITIVE EXPIRATORY PRESSURE (PEP) THERAPY VERSUS INCENTIVE SPIROMETRY IN ACUTE SICKLE CELL CRISIS

B. Batts, MPH, RRT, Hughes Spalding Children's Hospital, L. Hsu MD, PhD, Emory University, Hughes Spalding Children's Hospital, & GA Comprehensive Sickle Cell Center, J. L. Rau, PhD, RRT, Georgia State University, Atlanta, GA

Introduction: Positive expiratory pressure (PEP) therapy offers an alternative to traditional incentive spirometry (IS) in preventing atelectasis and subsequent acute chest syndrome in sickle cell disease. Purpose: This study examined the effect of PEP therapy in comparison with conventional IS therapy in reducing pulmonary complications and progression to acute chest syndrome (ACS) in pediatric sickle cell patients admitted for pain.

Methods:
Pediatric patients with acute sickle cell pain with or without concurrent fever, pulmonary infiltrates, pneumonia or asthma were eligible and randomly assigned to receive either IS or PEP therapy. Baseline measures included vital signs, pulse oximetry on room air, and level of oxygen support. Other clinical measures were obtained per usual protocol in the hospital. All patients recruited were instructed in use of either the IS (Coach-2?) or PEP (TheraPEP?) device, both DHD, Inc., Canastota, NY. With IS therapy, patients were instructed to take 10 maximal inspirations q. 1 hour while awake, with 5 deep breaths every 15 minutes approximately. With PEP, patients were given the same frequency schedule but told to take 10 normal or slightly larger breaths, and expiratory resistance was adjusted to give an approximate I:E ratio of 1 to 3 or 4, with a pressure between 10 and 20 cm H2O. Primary outcome measures were length of stay (LOS) and patient satisfaction with the therapy. Due to the small sample size in this pilot trial, only descriptive statistics are reported.

Results:
Baseline measures on admission were similar for the two groups except for age and gender. Means (standard deviations) are given.

Baseline: Age Sex Resp Rate Temp SpO2 FIO2
IS (n=5) 7.6 (4-12) M=3 24 (5.8) 36.0 (3.5) 97.2 (1.9) 0.21 ((0)
PEP(n=5) 12.6 (9-18) M=1 23 (3.9) 36.8 (0.4) 98.6 (1.5) 0.22 (0.01)

The mean (standard deviation) LOS for IS compared to PEP was 4.4 days (2.3) versus 6.6 days (2.9) respectively. For the IS and PEP groups, patient satisfaction scores were 4.4 (0.5) and 4.8(0.4) respectively.

Conclusions:
PEP therapy was accepted as well as IS, as indicated by responses on ease of use and comfort, with a slight advantage seen with PEP on these scores. A larger trial is needed to determine if LOS and other clinical outcomes differ between the two forms of bronchial therapy.
Study partially funded by DHD Healthcare, Inc., Canastota, NY.

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