2003 OPEN FORUM Abstracts
INTRAPULMONARY PERCUSSIVE VENTILATION IN THE NON-INTUBATED PEDIATRIC PATIENT: A RETROSPECTIVE REVIEW
Charlie Diaz BS, RRT, Children's Mercy Hospital, Kansas City, MO
Background: Intrapulmonary Percussive Ventilation (IPV) is a methodology directed toward the resolution of pulmonary atelectasis, as well as the mobilization and elimination of retained endobronchial secretions. IPV® is a combination of therapeutic regimes including high-density aerosol delivery, percussive step inflation of the lung, and stabilization of the airways; through this sequential inflation process collapsed airways are re-recruited. The purpose of this retrospective study was to determine if IPV was associated with any objective evidence of clinical improvement within the first 24 hours of therapy.
Method: This retrospective study examined 77 patients from January 2001 through December 2002 who had evidence of atelectasis. Patients connected to the IPV-1/Impulsator unit via mask. The IPV frequency was initiated at 300 cycles per minute for the first five minutes followed by a gradual reduction to 100 cycles per minute over 10 minutes, with a return to 300 cycles per minute for the final 5 minutes with 2.5mg Albuterol and 20mL normal saline. Radiographic evaluation of atelectasis was quantified a staff radiologist, utilizing an ordinal scale, where 4 = complete collapse of 2 or more segments or lobes, 3 = complete collapse of 1 segment or lobe, 2 = partial collapse of 2 or more segments or lobes, 1 = partial collapse of 1 segment or lobe, and 0 = no atelectasis. Differences in median values before and after 24 hours of therapy were compared with the Mann-Whitney Rank Sum Test with significance sat at p < 0.05.
RESULTS: The median age of patients studied was 5.7 years (range 5 days to 17 years). Radiology score improved significantly from 3 to 1 (p< 0.001).
CONCLUSION: This retrospective analysis demonstrates that IPV is associated with a significant and clinically important improvement in atelectasis. While these results are exciting we must remember, that is that it's difficult to ascertain if the intervention altered the eventual outcome with respect to the resolution of atelectasis. This study suggests that a controlled, randomized prospective study be performed.