title: Positive expiratory pressure (PEP) treatment in children with multiple severe disabilities.
abstract: BACKGROUND
  Children with multiple severe disabilities cannot be spontaneously physically active and therefore lack the ventilatory stimulation of physical activity. They often produce large quantities of airway mucus, which they have difficulty to evacuate on their own. The accumulation of mucus may lead to respiratory insufficiency.
  
  
  OBJECTIVE
  To investigate whether chest physiotherapy with positive expiratory pressure (PEP) could improve the blood oxygen tension (PO(2)) and/or decrease carbon dioxide tension (PCO(2)) in severely disabled children with airway mucus accumulation.
  
  
  METHODS
  Eighteen disabled children (mean age 7.5 y, SD 4.3, range 1.7-17.8 y) participated in the study. Transcutaneous (tc) PO(2), tcPCO(2) and respiratory rate (RR) were recorded before and after PEP treatment. The reproducibility of the effect of the treatment was tested by repeating the recordings.
  
  
  RESULTS
  The mean tcPO(2) increased 1.0 kPa (range -0.2 to 3.4 kPa) immediately after PEP treatment (p=0.0001). No significant changes in tcPCO(2) or RR were noted. The reproducibility of the effect of PEP treatment was good, with a significant increase in tcPO(2) at all retests. All children accepted the treatment well.
  
  
  CONCLUSIONS
  PEP increases blood oxygen tension immediately after treatment in severely disabled children with airway mucus accumulation. Long-term effects remain to be proven.
authors.affiliation: Department of Physiotherapy, The Queen Silvia Children's Hospital, Göteborg, Sweden. anna-lena.lagerkvist@vgregion.se
authors.forename: Anna-Lena
authors.initials: AL
authors.lastname: Lagerkvist
authors.forename: Gunilla
authors.initials: G
authors.lastname: Sten
authors.forename: Barbro
authors.initials: B
authors.lastname: Westerberg
authors.forename: Anne
authors.initials: A
authors.lastname: Ericsson-Sagsjö
authors.forename: Jan
authors.initials: J
authors.lastname: Bjure
mesh_terms: D000293:Adolescent; D001785:Blood Gas Monitoring, Transcutaneous; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D019988:Children with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D026741:Physical Therapy Modalities; D011175:Positive-Pressure Respiration; D012720:Severity of Illness Index