2005 OPEN FORUM Abstracts
A STUDY of INTRAPULMONARY PERCUSSIVE VENTILATION (IPV®) COMPARED TO ASSISTED AUTOGENIC DRAINAGE (AAD) AS AN ADJUNCTIVE PROTOCOL TO NEONATAL WEANING, FOLLOWING MECHANICAL VENTILATION.
Adel Bougatef MD, PhD, Ann Casteels MD, Filip Cools MD, Inne Loostermans RRT, 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 AAD. We hypothesized that IPV® reduces the rate of postextubation atelectasis, reintubation and improves gas exchange in premature neonates.
Methods: Sixty neonates (gestational age 29.3±1.5 weeks, birth weight 1308±259 gr) who were intubated for more than 72 hours were randomized at extubation to AAD n=30 or IPV® n= 30 at frequencies of 200-300 cycles/min and pressures 5-10 cm H2O. 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: Among the AAD patients seven (23%) developed post extubation atelectasis, four (13%) required reintubation for the resolution of the atelectasis. None of the patients receiving IPV® developed post extubation atelectasis or required reintubation; the differences with the AAD group were statistically significant (p< 0.05). The total duration of oxygen requirement after extubation, was 21.4±12 days in AAD group, and 15.7±12 days in IPV® group (p< 0.05). No significant difference were noted before therapy sessions in respect to heart rate, respiratory rate, PaO2, PaCO2, SaO2, and FIO2 between AAD and IPV® allocated patients. However, when IPV® was compared to AAD considering all of the variables after therapy sessions, there were statistical significances between both groups (p< 0.05).
|HR (beats/min)||158,2 ± 9,7||160 ± 10,1||142,8 ± 7,4||136 ± 7,2*|
|RR (breaths/min)||66,8 ± 10,2||68,4 ± 10,8||53,2 ± 6,1||44,4 ± 4,5*|
|FIO2 (%)||45,7 ± 5,3||43,5 ± 4||38,8 ± 5,1||32 ± 4,6*|
|PaCO2 mm Hg||45 ± 4,3||45,3 ± 3,1||45 ± 3,7||39,3 ± 2,6*|
|PaO2 mm Hg||61,3 ± 3,7||60,3 ± 4||68,7 ± 5,8||79,5 ± 5,7*|
|SaO2 (%)||91,7 ± 2,1||91,1 ± 1,8||94,6 ± 2,9||97,2 ± 1,6*|
Conclusions: Our findings indicate that intrapulmonary percussive ventilation was effective in preventing post extubation atelectasis in our babies, improved gas exchange, and reduced the fraction of inspired oxygen, as well as the duration of oxygen therapy after extubation.