2003 OPEN FORUM Abstracts
A comparison of intrapulmonary percussive ventilation and conventional chest physiotherapy as an adjunctive protocol to neonatal weaning after mechanical ventilation
A Bougatef, F Cools, A Casteels, I Loostermans, NICU, AZ-VUB, Brussels, Belgium.
Objectives: Intrapulmonary percussive ventilation (IPV) is a novel airway clearance modality to enhance mucociliary clearance and to treat persistent patchy atelectasis. IPV is administered with the Intrapulmonary Percussionator IPV-2 (Percussionaire corp., Sandpoint, Idaho). The device delivers a low-volume of gas at high frequency positive-pressure breaths in the range of 100 to 300 cycles/minute through a sliding venturi with added continuous aerosol generator. We conducted a prospective randomized study comparing the effect of IPV to conventional chest physiotherapy (CPT: autogenic drainage, forced expiration technique). We hypothesized that IPV reduces the rate of postextubation atelectasis, reintubation and improves gas exchange in premature neonates.
Methods: Thirty neonates (gestational age 30.5 ± 2.4 weeks) who were intubated for more than 72 hours were randomized at extubation to CPT n=15 or IPV n= 15 at frequencies of 200-300 cycles/min and pressures 5-10 cmH2O. Both treatments were given every 6 hours and lasted 15 min. No evidence of atelectasis on chest radiograph prior to extubation in both groups.
Results: Six of the 15 patients receiving CPT developed postextubation atelectasis and none of 15 patients receiving IPV developed atelectasis (p=0.017). Five infants in CPT group required reintubation to treat symptomatic atelectasis, no infants were reintubated in IPV group (p=0.04). Oxygen requirement changed from 48.3 ± 7.9 % before treatment to 31.4 ± 5.4 % after treatment with IPV and from 46.2 ± 4.8 % to 41.1 ± 5.1 % with CPT.
Conclusions: These results indicated that the incidence of postextubation atelectasis and the necessity of reintubation are lower with IPV in contrast to CPT. The IPV group showed more improvement in oxygenation and gas exchange than CPT group. IPV therapy following neonatal extubation is a safe and effective method of airway clearance.