2018 19 APR

Mechanical insufflation-exsufflation versus conventional chest physiotherapy in children with cerebral palsy

This article focuses on new devices for chest physiotherapy compared with traditional techniques in children with cerebral palsy

The objective of the study was to compare the efficacy in reducing hospital lenght and improvement of atelectasis between mechanical insufflation-exsufflation (MI-E) and Conventional chest physiotherapy (CPT) in children with quadriplegic spastic cerebral palsy with acute lower-respiratory infections.  There were 22 children enrolled in the study, 11 in the MI-E and 11 in the CPT group, the subjects had an age ranged from 7 months to 12 years and required airway clearance therapy. In all subjects with atelectasis of both groups, nebulization via EzPAP was used for helping lung expansion.  The CPT group received the treatment by a physiotherapist once per day, which consisted of a cycle of chest percussion, vibration, postural drainage, and manual assisted cough. These kind of children generally may be unable to endure CPT because of thoracic deformity, cognitive impairment, and inability to cooperate. Manual techniques are time-consuming and require specially trained clinicians. The MI-E group received MI-E 3 times per day and involved 3–5 cycles with a positive pressure to augment inspiration and then a negative pressure to enhance expiratory flow. Pressure and timing for each subject was adjusted according to amount of secretions, tolerance, and chest auscultation during each session by the physiotherapist. The device is effective at increasing cough peak flow for patients with reduced or no capacity to cough and expectorate. Moreover after the treatment there were less irritation, less pain, less tiring, and more comfort than conventional suctioning via tracheostomy tube.

Conclusions: there  was no significant difference in hospital length of stay between methods. MI-E is proven to be beneficial in shortening the duration of airway clearance in children with quadriplegic spastic cerebral palsy presenting with lower respiratory infections and atelectasis. MI-E is a safe and efficient intervention for airway clearance.

Siriwat R, Deerojanawong J et all. Mechanical Insufflation-Exsufflation Versus Conventional Chest Physiotherapy in Children With Cerebral Palsy. Respir Care. 2018 Feb;63(2):187-193.

Article by Alessandro Volpini