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

Abstract

BACKGROUND\nRespiratory 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.\n\n\nAIM\nTo investigate whether regular application of PEP through a face mask can improve clinical status and respiratory function in patients with severe CP.\n\n\nDESIGN\nObservational, retrospective cohort study.\n\n\nSETTING\nThe outpatient rehabilitation unit of the IRCCS E. Medea Rehabilitation Hospital -Conegliano, Italy.\n\n\nPOPULATION\nCP outpatients admitted to the unit between January 1, 2006 and December 31, 2018.\n\n\nMETHODS\nAll 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.\n\n\nSTATISTICAL ANALYSIS\nDescriptive statistics was applied for data analysis employing SPSS 16.0 software for Windows.\n\n\nRESULTS\nTwenty-one patients affected with CP (mean age 9,19 years, SD 5,56, range 3-23, 8 females) were included. All patients had more than 3 infections per year (mean 4,81, SD 1,17) in the year prior to treatment (T0). At T1 mean number of infections was 1,57 (SD 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.\n\n\nCONCLUSIONS\nDaily PEP-mask therapy reduces frequency of respiratory exacerbations in patients with severe bilateral CP.\n\n\nCLINICAL REHABILITATION IMPACT\nPEP-mask is a valuable rehabilitative tool in severe CP patients with frequent respiratory exacerbations.