{Reference Type}: Journal Article
{Title}: Lung volume recruitment and airway clearance for children at home in France.
{Author}: Khirani S;Griffon L;Thébault C;Aubertin G;Dupont P;Mbieleu B;Galodé F;Canavesio C;Fleurence E;Labouret G;Cros P;Barzic A;Lubrano Lavadera M;Giovannini-Chami L;Gilardoni JM;Gourdan P;Moreau J;Matecki S;Zitvogel F;Durand M;Perisson C;Le Clainche L;Taytard J;Fauroux B; ;
{Journal}: Respir Med
{Volume}: 231
{Issue}: 0
{Year}: 2024 Sep 29
{Factor}: 4.582
{DOI}: 10.1016/j.rmed.2024.107726
{Abstract}: <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.