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Published on: January 17, 2011
Lung volume recruitment and airway clearance for children at home in France
Sonia Khirani1, Lucie Griffon2, Charlotte Thébault3
1ASV Santé, F-92000, Gennevilliers, France; Pediatric noninvasive ventilation and sleep unit, AP-HP, Hôpital Necker-Enfants malades, F-75015, Paris, France; Université de Paris Cité, EA 7330 VIFASOM, F-75004, Paris, France.
Insights
Intermittent positive pressure breathing (IPPB) is the most common airway clearance technique (ACT) prescribed for children in France. Further studies are needed to validate the indications and settings for these vital respiratory treatments.
Area of Science:
- Pediatric Pulmonology
- Respiratory Therapy
- Medical Device Technology
Background:
- Airway clearance (ACT) and lung volume recruitment (LVR) techniques are crucial for managing bronchial secretions and preventing respiratory infections in children.
- These techniques improve cough efficiency and lung/chest wall recruitment, supporting children with respiratory conditions.
Purpose of the Study:
- To review the current prescription practices of ACT/LVR techniques for home use in pediatric patients across France.
- To understand the types of devices used, patient demographics, and reasons for initiation.
Main Methods:
- A national survey of pediatric noninvasive ventilation (NIV) network centers in France was conducted.
- Anonymous questionnaires collected data on children (≤20 years) using ACT/LVR devices (MI-E, IPPB, IPV, IMV/NIV) between 2022-2023.
Main Results:
- 139 patients from 13 centers were included; IPPB was most frequent (60%), followed by MI-E (31%) and IPV (22%).
- Devices were mainly prescribed by pediatric pulmonologists for children with neuromuscular disorders (47%) and neurodisability (27%).
- Key initiation criteria included cough assistance, airway clearance, thoracic mobilization, and vital capacity support.
Conclusions:
- Intermittent positive pressure breathing (IPPB) emerged as the most prescribed ACT/LVR technique in this pediatric cohort.
- The heterogeneity in prescribed diseases and initiation criteria highlights the necessity for evidence-based validation of ACT/LVR indications and device settings.
Background:
Airway clearance (ACT) and lung volume recruitment (LVR) techniques are used to manage bronchial secretions, increase cough efficiency and lung/chest wall recruitment, to prevent and treat respiratory tract infections. The aim of the study was to review the prescription of ACT/LVR techniques for home use in children in France.
Methods:
All the centers of the national pediatric noninvasive ventilation (NIV) network were invited to fill in an anonymous questionnaire for every child aged ≤20 years who started a treatment with an ACT/LVR device between 2022 and 2023. The devices comprised mechanical in-exsufflation (MI-E), intermittent positive pressure breathing (IPPB), intrapulmonary percussive ventilation (IPV), and/or invasive mechanical ventilation (IMV)/NIV for ACT/LVR.
Results:
One hundred and thirty-nine patients were included by 13 centers. IPPB was started in 83 (60 %) patients, MI-E in 43 (31 %) and IPV in 30 (22 %). No patient used IMV/NIV for ACT/LVR. The devices were prescribed mainly by pediatric pulmonologists (103, 74 %). Mean age at initiation was 8.9 ± 5.6 (0.4-18.5) years old. The ACT/LVR devices were prescribed mainly in patients with neuromuscular disorders (n = 66, 47 %) and neurodisability (n = 37, 27 %). The main initiation criteria were cough assistance (81 %) and airway clearance (60 %) for MI-E, thoracic mobilization (63 %) and vital capacity (47 %) for IPPB, and airway clearance (73 %) and repeated respiratory exacerbations (57 %) for IPV. The parents were the main carers performing the treatment at home.
Conclusions:
IPPB was the most prescribed technique. Diseases and initiation criteria are heterogeneous, underlining the need for studies validating the indications and settings of these techniques.
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