Background: Intrapulmonary percussive ventilation (IPV) is an airway clearance technique used at any age to facilitate the removal of secretions from the respiratory tract. The effect of IPV on gastroesophageal reflux(GER) is not well documented. This study aimed to determine the influence of IPV on GER in infants. Methods: During a 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH), infants in the intervention group received a20 minutes session of IPV in upright position, 2 hours postprandial. The control group received no intervention and was placed in the same position for 20 minutes, 2 hours postprandial. The number of reflux episodes (REs) during IPV as compared to the number of REs in the control group during the 20 minutes period. Results: Fifty infants were included in each group;21 infants in the IPV group and 14 infants in the control group were diagnosed with abnormal MII-pH (P = .142). During IPV, the number of REs was significantly lower than in the control group (P < .001). Also in the subgroups with abnormal or normal MII-pH, a significantly lower number of REs during IPV was found (P = .011, P = .011 respectively). Conclusion: IPV decreases the number of REs in infants independent of the results of MII-pH.
Background: The Prolonged Slow Expiration Technique (PSE) is an airway clearance technique (ACT) carried out in newborn children with bronchial obstruction and hypersecretion to clear away the mucus from the respiratory tract. Evidence about the effect of PSE on gastroesophageal reflux (GER) is currently lacking in the literature. This study aimed to evaluate the influence of PSE on GER in infants under the age of 1 year.Methods: Infants were observed using multichannel intraluminal impedance-pH monitoring (MII-pH) over 24 h. During monitoring, the participants were treated with one 20 min intervention of PSE in supine position, 2 h after feeding. In this controlled trial with intra-subject design, the number of reflux episodes (REs) during PSE were compared to 20 min before and after PSE.Results: Fifty infants younger than 1 year were screened of whom 22 had a pathological GER. For the entire group, no significant difference was seen in the total number of REs between before, during, or after the PSE treatment (P = 0.76). No significant difference in total REs was found between the three measuring points (P = 0.59) in the group of infants with an abnormal MII-pH (n = 22).Conclusion: PSE does not cause a significant difference in REs in infants younger than 1 year.Registration number: NCT03341585.
Assisted autogenic drainage (AAD) is an effective airway clearance technique (ACT) used in patients unable to carry out autogenic drainage independently to maintain respiratory function and prevent deterioration of bronchial obstruction or hypersecretion. 1 The technique, developed by Jean Chevaillier is characterized by controlled breathing using expiratory airflow to mobilise secretions from distal to proximal airways, without causing dynamic airway collapse. 1 AAD can be performed in different positions to alter regional ventilation and improve mucus clearance. 2,3 Its effectiveness has been showed in the treatment of hospitalised infants with bronchiolitis, 4 uncomplicated pneumonia 5 and cystic fibrosis. 6 In infants with acute bronchiolitis, AAD reduces significantly the length of hospital stay and respiratory symptoms of bronchial obstruction. 4 In infants with uncomplicated pneumonia, AAD might be considered safe and effective. 5 In infants with cystic fibrosis, AAD is effective but not superior to any other form of ACT. 6 The AAD technique is commonly used. In a large study in 166 centres in 27 different countries, one of three centres used AAD to treat infants with Cystic Fibrosis. 7 Sometimes, AAD is combined with bouncing (BAAD). This is a rhythmic up-and-down movement on a physioball to relax the baby and to enhance the expiratory air velocity.
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