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Positive expiratory pressure device acceptance by hospitalized children with sickle cell disease is comparable to
Lewis L Hsu1, Brenda K Batts, Joseph L Rau
1Pediatric Hematology, St Christopher's Hospital for Children, Drexel University College of Medicine, Erie Avenue at Front Street, Philadelphia PA 19134, USA. lhsu@mail.nih.gov
Insights
Intermittent positive expiratory pressure (PEP) therapy may be a viable alternative to incentive spirometry (IS) for preventing acute chest syndrome (ACS) in children with sickle cell disease, showing similar patient satisfaction and hospital stay durations.
Area of Science:
- Pediatric Pulmonology
- Hematology
- Critical Care Medicine
Background:
- Acute chest syndrome (ACS) is a severe complication of sickle cell disease (SCD) associated with high morbidity and mortality.
- Incentive spirometry (IS) is recommended for ACS prevention in SCD patients but can be challenging for children.
- Intermittent positive expiratory pressure (PEP) therapy presents a potentially more accessible alternative for pediatric SCD patients.
Purpose of the Study:
- To compare the efficacy of PEP therapy versus conventional IS in hospitalized children with SCD.
- To evaluate patient satisfaction, length of hospital stay, and progression to ACS between PEP and IS groups.
- To assess the feasibility of PEP as a preventive respiratory therapy in pediatric SCD management.
Main Methods:
- A pilot randomized trial involving 20 children hospitalized for sickle cell pain.
- Participants were randomly assigned to receive either PEP therapy (n=11) or IS (n=9).
- Respiratory therapies were administered hourly by a therapist while patients were awake.
Main Results:
- Patient satisfaction was high and comparable between the PEP and IS groups (4.5 vs 4.4, p=0.81).
- Hospital length of stay was similar for both groups (5 days vs 4.3 days, p=0.56).
- No participants in either group progressed to develop ACS.
Conclusions:
- Preliminary findings indicate no significant difference in patient satisfaction or hospital stay between PEP and IS therapies.
- PEP therapy shows promise as an alternative to IS for preventing ACS in at-risk pediatric SCD patients.
- Further research is warranted to explore intermittent PEP therapy's role in preventive respiratory care for SCD.
Background:
The pulmonary complication in sickle cell disease known as acute chest syndrome (ACS) has potential for high morbidity and mortality. A randomized trial demonstrated that incentive spirometry (IS) reduces the rate of ACS, leading to a role for respiratory therapy in hospital management of sickle cell pain. However, use of IS can be limited by chest wall pain, or by difficulty with the coordinated inspiration in a young child. Intermittent positive expiratory pressure (PEP) therapy may be easier for a child's coordination and more comfortable than IS for a child with chest wall pain.
Purpose:
To compare PEP therapy with conventional IS for children hospitalized for sickle cell pain with respect to patient satisfaction, length of hospital stay, and progression to ACS.
Methods:
This pilot study enrolled 20 children upon hospitalization for sickle cell pain in the thorax, randomly assigning them to either PEP (n = 11) or IS (n = 9) therapy, administered by a therapist hourly while awake.
Results:
The randomization assigned an older distribution to PEP than IS (12.3 vs 8.8 y). Patient satisfaction was high for both respiratory care devices, and there was no difference between the PEP and IS groups (4.5 vs 4.4, p = 0.81). Length of hospital stay was similar (5 vs 4.3 d, p = 0.56). No children in either group progressed to ACS.
Conclusion:
These preliminary results show no difference in the primary outcomes in the 2 groups. Intermittent PEP therapy warrants further study as an alternative to IS for sickle cell patients at high risk for ACS, as effective preventive respiratory therapy.
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