Use of intrapulmonary percussive ventilation (IPV) in the management of pulmonary complications of an infant with osteogenesis imperfecta

Abstract

Osteogenesis imperfecta (OI) is a genetic disorder characterized by abnormal collagen formation and short stature. These patients present with frequent vertebral, rib, and long bone fractures. There are many respiratory complications associated with OI including pneumonia, the most common cause of mortality in the severe forms of the disease. We present a case of an infant with OI (type III/IV) and significant tracheobronchomalacia who had required multiple hospitalizations for recurrent atelectasis and respiratory failure in the setting of acute respiratory infections. External chest percussion and vibration were avoided because of the risk of rib fractures. intrapulmonary percussive ventilation (IPV) was initiated during an acute illness with good effect, and continued successfully after discharge from hospital. We conclude that IPV represents a safe and effective alternative to airway clearance in infants with OI.

Influence of intrapulmonary percussive ventilation in upright position on gastro‐oesophageal reflux in infants

“…IPV has been shown to be effective and well tolerated when used as treatment for persistent atelectasis in adults and in children. 14 IPV improves airway secretion clearance in pediatric and adult patients with acute and chronic respiratory disease. 15 We studied the potential influence of IPV in upright position (IPV R ) on GOR in infants under the age of one year.…”

“…The intrapulmonary percussions are superimposed on the patient's spontaneous breathing, providing a baseline distending pressure that increases airway caliber. IPV has been shown to be effective and well tolerated when used as treatment for persistent atelectasis in adults and in children . IPV improves airway secretion clearance in pediatric and adult patients with acute and chronic respiratory disease …”

Skeletal dysplasia: Respiratory management during infancy

“…In such situations, airway clearance can be better achieved using intrapulmonary percussive ventilation. Mobilization of mucous is facilitated by delivering low volumes of positive pressure to the airways at high frequencies, creating an internal percussive effect [65]. …”

Pour ou contre la ventilation à percussions intrapulmonaires en réanimation ?

“…Contrairement aux autres techniques de kinésithérapie respiratoire, l'IPV dispense les thérapeutes d'une action manuelle sur la cage thoracique. Afin de limiter le risque de fracture de côte, Nino et al [22] ont ainsi utilisé l'IPV au cours d'une affection respiratoire aiguë chez un patient présentant une ostéogenèse imparfaite. L'IPV pourrait donc avoir une place dans la prise en charge de patients présentant des traumatismes thoraciques ou en phase postopératoire de chirurgie thoracique [23,24].…”