title: Positive expiratory pressure device acceptance by hospitalized children with sickle cell disease is comparable to incentive spirometry.
abstract: BACKGROUND
  The pulmonary complication in sickle cell disease known as acute chest syndrome (ACS) has potential for high morbidity and mortality. A randomized trial demonstrated that incentive spirometry (IS) reduces the rate of ACS, leading to a role for respiratory therapy in hospital management of sickle cell pain. However, use of IS can be limited by chest wall pain, or by difficulty with the coordinated inspiration in a young child. Intermittent positive expiratory pressure (PEP) therapy may be easier for a child's coordination and more comfortable than IS for a child with chest wall pain.
  
  
  OBJECTIVE
  To compare PEP therapy with conventional IS for children hospitalized for sickle cell pain with respect to patient satisfaction, length of hospital stay, and progression to ACS.
  
  
  METHODS
  This pilot study enrolled 20 children upon hospitalization for sickle cell pain in the thorax, randomly assigning them to either PEP (n = 11) or IS (n = 9) therapy, administered by a therapist hourly while awake.
  
  
  RESULTS
  The randomization assigned an older distribution to PEP than IS (12.3 vs 8.8 y). Patient satisfaction was high for both respiratory care devices, and there was no difference between the PEP and IS groups (4.5 vs 4.4, p = 0.81). Length of hospital stay was similar (5 vs 4.3 d, p = 0.56). No children in either group progressed to ACS.
  
  
  CONCLUSIONS
  These preliminary results show no difference in the primary outcomes in the 2 groups. Intermittent PEP therapy warrants further study as an alternative to IS for sickle cell patients at high risk for ACS, as effective preventive respiratory therapy.
authors.affiliation: Pediatric Hematology, St Christopher's Hospital for Children, Drexel University College of Medicine, Erie Avenue at Front Street, Philadelphia PA 19134, USA. lhsu@mail.nih.gov
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Hsu
authors.forename: Brenda K
authors.initials: BK
authors.lastname: Batts
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Rau
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D005260:Female; D005845:Georgia; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D008297:Male; D017060:Patient Satisfaction; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D013147:Spirometry