2012 OPEN FORUM Abstracts
A COMPARISON OF POSITIVE PRESSURE THERAPY AND CONVENTIONAL CHEST PHYSIOTHERAPY FOR THE PREVENTION AND TREATMENT OF POST-OPERATIVE ATELECTASIS IN CHILDREN AFTER CARDIAC SURGERY.
Tina M. Pitt1,3, Antonio Cabrera2, Mohammed Alsheikh Ali2; 1Education, Le Bonheur Childrens Hospital, Memphis, TN; 2Department of Pediatrics, Le Bonheur Childrens Hospital, Memphis, TN; 3Respiratory Care, Le Bonheur Childrens Hospital, Memphis, TN
Background: Atelectasis after pediatric cardiac surgery is a common problem; however, no standard measure exists for its prevention and treatment. Objective: Compare two commonly used respiratory therapies to prevent and treat atelectasis: positive pressure (PEP/PAP) and conventional chest physiotherapy (CPT). Method: A prospective randomized study was conducted on 16 patients who underwent cardiac surgery at Le Bonheur Childrens Hospital. Patients 0-5 years were randomized to CPT or EZPAP®. EZPAP® was provided via mask at 5 cm H2O with flow set at 5-8 lpm. Flow was provided via an oxygen blender using the same oxygen concentration the patient was receiving before starting the therapy. Patients performed 10 breaths, rested for 1 minute and repeated for a total of 5 cycles (50 breaths). Patients 6-18 years were randomized to conventional chest physiotherapy or TheraPEP®. TheraPEP® was provided via a mouthpiece with the patient exhaling for 3-4 seconds against 10-20 cm H2O for 10 breaths. A rest period of 1 minute followed and the therapy was repeated five more times for a total of 50 breaths. All treatments were given following extubation for a total of 72 hours. Baseline and subsequent daily chest radiographs were evaluated using an ordinal scoring system to measure the degree of atelectasis on chest radiographs until therapy was stopped. Results: The median age of patients receiving CPT was 6.2 years and for the PEP/PAP group was 10.2 years. There were 7male patients. There was a trend towards statistically significant improvement in atelectasis score in PAP/PEP group compared to CPT group (p = 0.086). There were no significant adverse events during or after CPT or PEP/PAP. Conclusions: CPT and PEP/PAP are safe therapies to prevent and/or treat atelectasis after cardiac surgery in children. There was a trend towards higher effectiveness in the PEP/PAP group. Sponsored Research - None