Lung volume recruitment and airway clearance for children at home in France.

airway clearance cough lung volume recruitment pediatrics respiratory physiotherapy thoracic expansion

Journal

Respiratory medicine
ISSN: 1532-3064
Titre abrégé: Respir Med
Pays: England
ID NLM: 8908438

Informations de publication

Date de publication:
29 Jun 2024
Historique:
received: 05 02 2024
revised: 06 06 2024
accepted: 29 06 2024
medline: 2 7 2024
pubmed: 2 7 2024
entrez: 1 7 2024
Statut: aheadofprint

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND 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 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 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 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.

Identifiants

DOI: 10.1016/j.rmed.2024.107726 PMID: 38950683
pubmed: 38950683
pii: S0954-6111(24)00201-4
doi: 10.1016/j.rmed.2024.107726
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

107726

Informations de copyright

Copyright © 2024. Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Declaration of Competing Interest ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ☐ The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

Auteurs

Sonia Khirani (S)

ASV 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. Electronic address: sonia_khirani@yahoo.fr.

Lucie Griffon (L)

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.

Charlotte Thébault (C)

Pediatric pulmonology department, AP-HP, Hôpital Armand Trousseau, F-75012 Paris.

Guillaume Aubertin (G)

Pediatric pulmonology department, AP-HP, Hôpital Armand Trousseau, F-75012 Paris; Sorbonne Université, INSERM UMR-S 938, Centre de Recherche Saint-Antoine (CRSA), F-75014 Paris, France; Centre de pneumologie de l'enfant, Ramsay Générale de Santé, 92100 Boulogne-Billancourt, France.

Pierre Dupont (P)

Pediatric intensive care unit, AP-HP, Hôpital Raymond Poincaré, F-92380 Garches, France.

Blaise Mbieleu (B)

Pediatric intensive care unit, AP-HP, Hôpital Raymond Poincaré, F-92380 Garches, France.

François Galodé (F)

Pediatric pulmonology unit, Hôpital Pellegrin-Enfants, CIC-P Bordeaux 1401, CHU de Bordeaux, 33076 Bordeaux, France.

Coline Canavesio (C)

SMR pédiatrique ESEAN APF France handicap (Paediatric Rehabilitation Services), F-44200 Nantes, France.

Emmanuelle Fleurence (E)

SMR pédiatrique ESEAN APF France handicap (Paediatric Rehabilitation Services), F-44200 Nantes, France.

Geraldine Labouret (G)

Pediatric pulmonology and allergology unit, Hôpital des Enfants, 31000 Toulouse, France.

Pierrick Cros (P)

Pediatric department, CHU Brest, 29200 Brest, France.

Audrey Barzic (A)

Pediatric department, CHU Brest, 29200 Brest, France.

Marc Lubrano Lavadera (M)

Respiratory Diseases, Allergy and CF Unit, Pediatric Department, University Hospital Charles Nicolle, 76000 Rouen, France.

Lisa Giovannini-Chami (L)

Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.

Jean-Marc Gilardoni (JM)

Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.

Pierre Gourdan (P)

Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.

Johan Moreau (J)

Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000 Montpellier, France; Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, 34000 Montpellier, France.

Stefan Matecki (S)

Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000 Montpellier, France; Functional Exploration Laboratory, Physiology Department, University Hospital, 34000 Montpellier, France.

Françoise Zitvogel (F)

Pediatric intensive care unit, CHU Strasbourg, 67000 Strasbourg, France.

Marine Durand (M)

Service des maladies neurologiques rares, CHU SUD Réunion, F-97448 Saint Pierre, La Réunion, France.

Caroline Perisson (C)

Service des maladies neurologiques rares, CHU SUD Réunion, F-97448 Saint Pierre, La Réunion, France.

Laurence Le Clainche (L)

Pediatric noninvasive ventilation department, AP-HP, Hôpital Robert Debré, F-75018 Paris, France.

Jessica Taytard (J)

Pediatric pulmonology department, AP-HP, Hôpital Armand Trousseau, F-75012 Paris; Sorbonne Université, INSERM UMR-S 1158, Paris, France.

Brigitte Fauroux (B)

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.

Classifications MeSH