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Positive expiratory pressure to enhance cough effectiveness in tracheomalacia

Sanitra Sirithangkul1, Sarath Ranganathan, Philip J Robinson

  • 1Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand. sanitras@hotmail.com

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|February 2, 2011
PubMed

Insights

Increasing Positive Expiratory Pressure (PEP) during coughing enhances expiratory flow in children with repaired tracheo-esophageal fistula (TOF). This technique may improve cough efficiency, aiding in managing tracheomalacia.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Physiology
  • Medical Device Technology

Background:

  • Children with repaired tracheo-esophageal fistula (TOF) may have compromised airway function, particularly tracheomalacia.
  • Effective airway clearance techniques are crucial for managing respiratory complications in this population.

Purpose of the Study:

  • To evaluate the impact of varying levels of Positive Expiratory Pressure (PEP) on cough effectiveness.
  • To determine if PEP can enhance expiratory flow and improve cough efficiency in children.

Main Methods:

  • A study involving 40 children with repaired TOF and 21 controls aged 8-18 years.
  • Cough spirometry was performed with adjustable PEP levels (0-20 cmH2O).
  • Cough expiratory flow between 75% and 25% of vital capacity (CEF25-75) was analyzed.

Main Results:

  • In the TOF group, CEF25-75 significantly increased at PEP levels of 5, 10, and 15 cmH2O.
  • The optimal PEP level for enhancing CEF25-75 in the TOF group appeared to be 5 cmH2O.
  • In the control group, CEF25-75 generally decreased with increasing PEP levels.

Conclusions:

  • A simple adjustable PEP valve can augment cough expiratory flow in children.
  • PEP during coughing may be a valuable addition to chest physiotherapy for children with tracheomalacia.
Abstract

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