Abstract：
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: 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: 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: 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.
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: 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: 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.
摘要：
背景：气道清除（ACT）和肺容量募集（LVR）技术用于管理支气管分泌物，增加咳嗽效率和肺/胸壁募集，预防和治疗呼吸道感染。该研究的目的是回顾法国儿童家庭使用的ACT/LVR技术的处方。
方法：邀请国家儿科无创通气（NIV）网络的所有中心为每个年龄≤20岁的儿童填写匿名问卷，这些儿童在2022年至2023年之间开始使用ACT/LVR设备进行治疗。这些装置包括机械排气(MI-E)，间歇性正压呼吸（IPPB），肺内冲击通气（IPV），和/或用于ACT/LVR的有创机械通气(IMV)/NIV。
结果：13个中心纳入了139名患者。83例（60%）患者开始IPPB，MI-E为43（31%），IPV为30（22%）。没有患者使用IMV/NIV进行ACT/LVR。这些设备主要由儿科肺科医师（103，74％）处方。开始时的平均年龄为8.9±5.6（0.4-18.5）岁。ACT/LVR设备主要用于神经肌肉疾病（n=66，47％）和神经残疾（n=37，27％）的患者。MI-E的主要起始标准是咳嗽辅助（81％）和气道清除（60％），IPPB的胸腔动员(63%)和肺活量(47%)，和气道清除率（73％）和反复呼吸加重（57％）的IPV。父母是在家进行治疗的主要照顾者。
结论：IPPB是最常用的技术。疾病和启动标准是不同的，强调需要研究验证这些技术的适应症和设置。
方法：邀请国家儿科无创通气（NIV）网络的所有中心为每个年龄≤20岁的儿童填写匿名问卷，这些儿童在2022年至2023年之间开始使用ACT/LVR设备进行治疗。这些装置包括机械排气(MI-E)，间歇性正压呼吸（IPPB），肺内冲击通气（IPV），和/或用于ACT/LVR的有创机械通气(IMV)/NIV。
结果：13个中心纳入了139名患者。83例（60%）患者开始IPPB，MI-E为43（31%），IPV为30（22%）。没有患者使用IMV/NIV进行ACT/LVR。这些设备主要由儿科肺科医师（103，74％）处方。开始时的平均年龄为8.9±5.6（0.4-18.5）岁。ACT/LVR设备主要用于神经肌肉疾病（n=66，47％）和神经残疾（n=37，27％）的患者。MI-E的主要起始标准是咳嗽辅助（81％）和气道清除（60％），IPPB的胸腔动员(63%)和肺活量(47%)，和气道清除率（73％）和反复呼吸加重（57％）的IPV。父母是在家进行治疗的主要照顾者。
结论：IPPB是最常用的技术。疾病和启动标准是不同的，强调需要研究验证这些技术的适应症和设置。
