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ORIGINAL ARTICLE   Free accessfree

European Journal of Physical and Rehabilitation Medicine 2020 February;56(1):68-72

DOI: 10.23736/S1973-9087.19.05794-0


language: English

Reduction in respiratory exacerbation rate in patients with severe bilateral cerebral palsy following daily PEP-mask therapy: a retrospective study

Chiara DI PEDE 1 , Elena COLOMBO 1, Miriam DUSO 2, Davide CONTE 1, Vittoria MARCON 1, Andrea VIANELLO 3, Stefano MASIERO 2, Andrea MARTINUZZI 1

1 Unit of Neurorehabilitation, IRCCS E. Medea Rehabilitation Hospital, Conegliano, Treviso, Italy; 2 Department of Neuroscience, University of Padua, Padua, Italy; 3 Division of Respiratory Pathophysiology and Intensive Care, University-City Hospital, Padua, Italy

BACKGROUND: Respiratory complications caused by the inability to protect the upper airways and ineffective cough represent a major cause of morbidity and mortality in patients with cerebral palsy (CP). Even though the application of positive end-expiratory pressure (PEP) through a face mask has gained large popularity as a technique to prevent bronchial mucous encumbrance, its long-term effects on clinical course and respiratory function in individuals with CP have not been investigated.
AIM: The aim of this study is to investigate whether regular application of PEP through a face mask can improve clinical status and respiratory function in patients with severe CP.
DESIGN: Observational, retrospective cohort study.
SETTING: The outpatient rehabilitation unit of the IRCCS E. Medea Rehabilitation Hospital in Conegliano, Italy.
POPULATION: CP outpatients admitted to the unit between January 1st, 2006 and December 31st, 2018.
METHODS: All the medical records of the enrolled patients were collected and reviewed. All patients underwent multidisciplinary respiratory evaluation at T0 (immediately before the beginning of PEP-use) and T1 (12 months after). The evaluation assessed respiratory infections history (number of exacerbations per year), blood gas analysis, measurement of airway resistance through the interrupter technique.
RESULTS: Twenty-one patients affected with CP (mean age 9.19±5.56 years, range 3-23 years, 8 females) were included. All patients had more than 3 infections per year (mean 4.81±1.17) in the year prior to treatment (T0). At T1 mean number of infections was 1.57±0.81); 17 patients (80%) reported less than three infections; two patients (10%) reported zero infections, two patients (10%) reported three infections. Blood gas analysis and airway resistance values did not show a significant difference at T0 and T1.
CONCLUSIONS: Daily PEP-mask therapy reduces frequency of respiratory exacerbations in patients with severe bilateral CP.
CLINICAL REHABILITATION IMPACT: PEP-mask is a valuable rehabilitative tool in severe CP patients with frequent respiratory exacerbations.

KEY WORDS: Positive-pressure respiration; Cerebral palsy; Respiratory tract infections

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